Individual
ASHLEY NICOLE VAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13671 ROSALIND DR, TUSTIN, CA 92780-1924
(949) 296-4545
Mailing address
13671 ROSALIND DR, TUSTIN, CA 92780-1924
(949) 296-4545
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
704147
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F2610710
CA DRIVERS LICENSE
CA
Enumeration date
10/06/2021
Last updated
10/06/2021
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