Most Relevant Information
Provider Data
NPI Number: | 1003291188 |
Provider Name: | TRISTA NICOLE SOS LVN |
Entity Type: | Individual |
Taxonomy Code: | 164X00000X |
Specialty: | Licensed Vocational Nurse |
License Number: | VN 247964 |
Most Important Dates
Enumeration Date: | 07/30/2015 |
Last Updated: | 07/30/2015 |
Provider Practice Location
1907 TIBURON DR
REDDING
CA
960039232
Practice Location Phone/Fax
Phone: | 7073621751 |
Fax: |
Provider Mailing Location
1907 TIBURON DR
REDDING
CA
96003
Provider Mailing Phone/Fax
Phone: | 7073621751 |
Fax: |