Healthcare Provider Details

I. General information

NPI: 1649490111
Provider Name (Legal Business Name): MRS. SHEILA ELAINE ROSENEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. SHEILA ELAINE JEFFERS

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6302 THIRTEENTH AVENUE
LUCERNE CA
95458-1024
US

IV. Provider business mailing address

PO BOX 1024
LUCERNE CA
95458-1024
US

V. Phone/Fax

Practice location:
  • Phone: 707-274-9101
  • Fax: 707-274-9192
Mailing address:
  • Phone: 707-274-9101
  • Fax: 707-274-9192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: