Individual
MS. ALICE LANE THERRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, FNP-BC
Contact information
Practice address
4160 SUISUN VALLEY RD #132, FAIRFIELD, CA 94534
(530) 304-7659
Mailing address
PO BOX 1198-1379, SACRAMENTO, CA 95812
(530) 304-7659
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
797771
CA
363LF0000X
Family Nurse Practitioner
Primary
23149
CA
Other
Enumeration date
11/25/2013
Last updated
11/25/2013
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