Healthcare Provider Details

I. General information

NPI: 1114840378
Provider Name (Legal Business Name): PATRICIA DIANNE WALDON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 KINGSLEY WAY
RIVERSIDE CA
92504-2762
US

IV. Provider business mailing address

7410 KINGSLEY WAY
RIVERSIDE CA
92504-2762
US

V. Phone/Fax

Practice location:
  • Phone: 951-852-1561
  • Fax:
Mailing address:
  • Phone: 951-852-1561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95435424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: