Healthcare Provider Details

I. General information

NPI: 1790082717
Provider Name (Legal Business Name): HELEN MAE ALDREDGE RN, BSN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 W 109TH ST
LOS ANGELES CA
90047-4619
US

IV. Provider business mailing address

1609 W 109TH ST
LOS ANGELES CA
90047-4619
US

V. Phone/Fax

Practice location:
  • Phone: 323-777-8193
  • Fax:
Mailing address:
  • Phone: 323-777-8193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number358813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: