Healthcare Provider Details

I. General information

NPI: 1790089506
Provider Name (Legal Business Name): CHRISTINA JOAN ANDRADE RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINA JOAN RIVERA RN, CNS

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BICENTENNIAL WAY
SANTA ROSA CA
95403-2149
US

IV. Provider business mailing address

401 BICENTENNIAL WAY
SANTA ROSA CA
95403-2149
US

V. Phone/Fax

Practice location:
  • Phone: 707-393-3129
  • Fax: 707-393-4863
Mailing address:
  • Phone: 707-393-3129
  • Fax: 707-393-4863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number682435
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: