Healthcare Provider Details

I. General information

NPI: 1902107006
Provider Name (Legal Business Name): LUCINDA LEE WASSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2010
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MOUNT VERNON AVE 2ND FLOOR
BAKERSFIELD CA
93306-3302
US

IV. Provider business mailing address

1800 MOUNT VERNON AVE 2ND FLOOR
BAKERSFIELD CA
93306-3302
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-0400
  • Fax: 661-868-0218
Mailing address:
  • Phone: 661-868-0400
  • Fax: 661-868-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number255315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: