Healthcare Provider Details

I. General information

NPI: 1063329050
Provider Name (Legal Business Name): ACHLEE ELIZABETH RODARMEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 ELYSIAN BLVD
BIG BEAR CITY CA
92314-9155
US

IV. Provider business mailing address

441 ELYSIAN BLVD
BIG BEAR CITY CA
92314-9155
US

V. Phone/Fax

Practice location:
  • Phone: 559-936-6914
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95041167
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: