Healthcare Provider Details

I. General information

NPI: 1134260763
Provider Name (Legal Business Name): LENETTE ARVILLA MAPES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 JOHNSON BLVD SUITE 103
SOUTH LAKE TAHOE CA
96150-8220
US

IV. Provider business mailing address

PO BOX 5028
STATELINE NV
89449-5028
US

V. Phone/Fax

Practice location:
  • Phone: 530-573-3144
  • Fax: 530-541-8409
Mailing address:
  • Phone: 775-588-7775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number473761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: