Basic Information
| Provider Information | |||||||||
| NPI: | 1982801692 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUETTEMAN | ||||||||
| FirstName: | LEA | ||||||||
| MiddleName: | LINETTE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RN,PHN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 441 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ALTURAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 961013457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302336312 | ||||||||
| FaxNumber: | 5302335311 | ||||||||
| Practice Location | |||||||||
| Address1: | 441 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ALTURAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 961013457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302336312 | ||||||||
| FaxNumber: | 5302335311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN200410 | CA | Y | Nursing Service Providers | Registered Nurse | 163W00000X | PHN45504 | CA | N | Nursing Service Providers | Registered Nurse |
No ID Information.