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General NPI Number Information
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NPI Number | 1821436627
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Entity Type | Individual
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Provider Name | KRISTEN EILEEN CLEVENGER N.P.
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Gender | Female
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Dates
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Enumeration Date | 06/13/2013
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Last Update Date | 06/13/2013
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Provider Practice Location Address
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Address Line | 550 N FLOWER ST
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City | SANTA ANA
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State | CA
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Zip | 92703-2361
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Country | US
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Telephone | 714-641-4665
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Fax | 714-647-7496
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Provider Business Mailing Address
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Address Line | 332 SARAH AVE
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City | PLACENTIA
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State | CA
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Zip | 92870-1938
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Country | US
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Telephone | 949-275-0944
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 428923
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License Number State | CA
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