Healthcare Provider Details

I. General information

NPI: 1063924843
Provider Name (Legal Business Name): AMY KAY FOLAND CRNA; RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 MAGNOLIA AVE
RIVERSIDE CA
92505-3043
US

IV. Provider business mailing address

28541 ERIDANUS DR
MENIFEE CA
92586-3822
US

V. Phone/Fax

Practice location:
  • Phone: 951-353-4819
  • Fax: 951-353-5080
Mailing address:
  • Phone: 951-378-1777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number766462
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: