Healthcare Provider Details

I. General information

NPI: 1629226485
Provider Name (Legal Business Name): MS. LAURIE SUSAN BLUESTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 W MAIN ST
VISALIA CA
93291-4599
US

IV. Provider business mailing address

2325 W MAIN ST
VISALIA CA
93291-4599
US

V. Phone/Fax

Practice location:
  • Phone: 559-624-1097
  • Fax: 559-624-1086
Mailing address:
  • Phone: 559-624-1097
  • Fax: 559-624-1086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number73409
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number721149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: