Healthcare Provider Details

I. General information

NPI: 1851449169
Provider Name (Legal Business Name): HEATHER ALLYN REDMOND-ARCHER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER ALLYN REDMOND RN

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 E DAKOTA AVE STE G
FRESNO CA
93726-4821
US

IV. Provider business mailing address

1925 E DAKOTA AVE STE G
FRESNO CA
93726-4821
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-4645
  • Fax:
Mailing address:
  • Phone: 559-600-4645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number564564
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: