Individual
HEATHER CHILDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
116 AGNES AVE, SANTA MARIA, CA 93458-2838
(805) 457-3724
Mailing address
116 AGNES AVE, SANTA MARIA, CA 93458-2838
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
275667
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1205480563
TELECARE AGNES AVE
—
Enumeration date
11/18/2019
Last updated
11/18/2019
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