Healthcare Provider Details

I. General information

NPI: 1013530534
Provider Name (Legal Business Name): ERNESTINA ELIZABETH MCGREW RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 RUSTIN AVE
RIVERSIDE CA
92507-2498
US

IV. Provider business mailing address

14192 SAN CRISTOBAL BAY DR
MORENO VALLEY CA
92553-2907
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-2105
  • Fax:
Mailing address:
  • Phone: 951-807-6430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number693114
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number693114
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number693114
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number693114
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number693114
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number693114
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number693114
License Number StateCA
# 8
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number693114
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: