MEDICARE: MR. TOD IMPERATO APRN

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	363L00000X	Nurse Practitioner	95007149	CA

General Provider Information

NPI Number	:	1942726252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TOD IMPERATO APRN

Provider Business Mailing Address
First Line	:	242 HOSPITAL DR STE B
Second Line	:
City	:	UKIAH
State	:	CA
Zip	:	95482-4556
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	232 HOSPITAL DR STE B
Second Line	:
City	:	UKIAH
State	:	CA
Zip	:	95482-4562
Country	:	US
Telephone Number	:	707-467-4994
Fax Number	:

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

Provider Enumeration Date	:	08/17/2017
Last Update Date	:	08/17/2017

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