Healthcare Provider Details

I. General information

NPI: 1417006750
Provider Name (Legal Business Name): SHENEEKA ANDERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 NORTH COTTONWOOD STREET
WOODLAND CA
95695
US

IV. Provider business mailing address

187 W LINCOLN AVE
WOODLAND CA
95695-3777
US

V. Phone/Fax

Practice location:
  • Phone: 530-666-8645
  • Fax: 530-669-1549
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number636502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: