Healthcare Provider Details

I. General information

NPI: 1043922693
Provider Name (Legal Business Name): SOUK CRAFT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E AVENUE K6 STE B
LANCASTER CA
93535-4645
US

IV. Provider business mailing address

335 E AVENUE K6 STE B
LANCASTER CA
93535-4645
US

V. Phone/Fax

Practice location:
  • Phone: 661-471-4810
  • Fax: 661-524-2373
Mailing address:
  • Phone: 661-471-4810
  • Fax: 661-524-2373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number95122148
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: