Healthcare Provider Details

I. General information

NPI: 1730362690
Provider Name (Legal Business Name): ALICE JEAN KIENZLE RN/PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 MIRA LOMA DR NURSING DIVISION
OROVILLE CA
95965-3500
US

IV. Provider business mailing address

202 MIRA LOMA DR NURSING DIVISION
OROVILLE CA
95965-3500
US

V. Phone/Fax

Practice location:
  • Phone: 530-538-7831
  • Fax: 530-538-7297
Mailing address:
  • Phone: 530-538-7831
  • Fax: 530-538-7297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number289342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: