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: |