Basic Information
| Provider Information | |||||||||
| NPI: | 1922646983 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | PALKKI | ||||||||
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| Credential: | BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2624 PIEDMONT AVE | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910201385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012340132 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1720 E CESAR E CHAVEZ AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900332414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232685000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2019 | ||||||||
| LastUpdateDate: | 12/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/20/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 95201704 | CA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.