Healthcare Provider Details

I. General information

NPI: 1255518338
Provider Name (Legal Business Name): VASANA KRASAESIN ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43839 15TH ST W
LANCASTER CA
93534-4756
US

IV. Provider business mailing address

43839 15TH ST WEST
LANCASTER CA
93534
US

V. Phone/Fax

Practice location:
  • Phone: 661-945-5984
  • Fax: 661-723-6446
Mailing address:
  • Phone: 661-945-5984
  • Fax: 661-723-6446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number344883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: