Healthcare Provider Details

I. General information

NPI: 1174099295
Provider Name (Legal Business Name): KRISTIN ANNE NURRE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N ROSE AVE STE 350
OXNARD CA
93030-7627
US

IV. Provider business mailing address

3400 DATA DR ATTN: CREDENTIALING/PAYER ENROLLMENT
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 805-485-7877
  • Fax: 805-981-4472
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010246
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: