Individual
KELLY ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
13030 COLONIAL DR, RANCHO CUCAMONGA, CA 91739-8866
(310) 367-6963
Mailing address
13030 COLONIAL DR, RANCHO CUCAMONGA, CA 91739-8866
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
RN95245715
CA
Other
Enumeration date
05/08/2024
Last updated
05/08/2024
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