MEDICARE: MRS. JEAN MARY FOLKERTH CRNFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	205082	CA

General Provider Information

NPI Number	:	1881744928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEAN MARY FOLKERTH CRNFA

Provider Business Mailing Address
First Line	:	3998 VISTA WAY
Second Line	:	SUITE A
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4515
Country	:	US
Telephone Number	:	760-726-2500
Fax Number	:	760-726-3279

Provider Business Practice Location Address
First Line	:	3998 VISTA WAY
Second Line	:	SUITE A
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4515
Country	:	US
Telephone Number	:	760-726-2500
Fax Number	:	760-726-3279

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/22/2015

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