Provider Demographics
NPI:1033835202
Name:LEMKE, VICKI B (RN)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:B
Last Name:LEMKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2569 BEVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-5961
Mailing Address - Country:US
Mailing Address - Phone:559-797-6536
Mailing Address - Fax:
Practice Address - Street 1:2569 BEVERLY AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-5961
Practice Address - Country:US
Practice Address - Phone:559-797-6536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA708506163WM0705X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA708506OtherLICENSE
CAN8398539Medicaid
CA708506OtherLISCENCE