Healthcare Provider Details

I. General information

NPI: 1124211289
Provider Name (Legal Business Name): WILLOWS UNIFIED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 W LAUREL ST
WILLOWS CA
95988-2946
US

IV. Provider business mailing address

823 W LAUREL ST
WILLOWS CA
95988-2946
US

V. Phone/Fax

Practice location:
  • Phone: 530-934-6600
  • Fax: 530-934-6609
Mailing address:
  • Phone: 530-934-6600
  • Fax: 530-934-6609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. CAROL A ANDERSON
Title or Position: SCHOOL DISTRICT NURSE
Credential:
Phone: 530-934-6640