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General NPI Number Information
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NPI Number | 1841896396
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Entity Type | Individual
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Provider Name | KINDEL GRACE CHURCH NP
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Gender | Female
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Dates
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Enumeration Date | 12/09/2020
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 11234 ANDERSON ST
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City | LOMA LINDA
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State | CA
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Zip | 92354-2804
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Country | US
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Telephone | 909-558-5967
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Fax |
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Provider Business Mailing Address
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Address Line | 10 GLICINA ST
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City | RANCHO MISSION VIEJO
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State | CA
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Zip | 92694-1824
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Country | US
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Telephone | 949-306-0685
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 95016118
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License Number State | CA
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