Healthcare Provider Details

I. General information

NPI: 1558173054
Provider Name (Legal Business Name): KENDELL RAE ROGERS STANDIFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8115 SENECA DR
RENO NV
89506-9116
US

IV. Provider business mailing address

8115 SENECA DR
RENO NV
89506-9116
US

V. Phone/Fax

Practice location:
  • Phone: 775-276-0938
  • Fax:
Mailing address:
  • Phone: 775-276-0938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number836283
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: