Healthcare Provider Details

I. General information

NPI: 1376852640
Provider Name (Legal Business Name): SUSAN G KORDELL RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4031 W NOBLE AVE
VISALIA CA
93277-1631
US

IV. Provider business mailing address

4031 W NOBLE AVE
VISALIA CA
93277-1631
US

V. Phone/Fax

Practice location:
  • Phone: 559-623-0189
  • Fax: 559-624-1086
Mailing address:
  • Phone: 559-623-0189
  • Fax: 559-624-1086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number240144
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: