Facts
- Status
- A
- Credential
- RN
- Type
- Individual
- Enumeration date
- 2024-04-04
- Last updated
- 2024-04-04
Specialties
Licenses
- License CA
- 622407
Location
- Practice location
- 23406 VOLCANO WAY
- City
- RED BLUFF CA
- Postal code
- 960808863
- Phone
- 530-526-6204
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.