MEDICARE: MS. YELENA MARIE KOLODJI RN, CNM

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	176B00000X	Midwife	704	CA

General Provider Information

NPI Number	:	1962525352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YELENA MARIE KOLODJI RN, CNM

Provider Business Mailing Address
First Line	:	20941 NEZ PERCE TRL
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95033-8882
Country	:	US
Telephone Number	:	408-353-1118
Fax Number	:	408-353-1119

Provider Business Practice Location Address
First Line	:	20941 NEZ PERCE TRL
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95033-8882
Country	:	US
Telephone Number	:	408-353-1118
Fax Number	:	408-353-1119

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/08/2007

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