Healthcare Provider Details

I. General information

NPI: 1093999047
Provider Name (Legal Business Name): MONICA EAST SODERSTROM RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 OLEANDER AVE
CHICO CA
95926-3924
US

IV. Provider business mailing address

695 OLEANDER AVE
CHICO CA
95926-3924
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-2869
  • Fax: 530-879-3309
Mailing address:
  • Phone: 530-891-2869
  • Fax: 530-879-3309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number390705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: