Basic Information
Provider Information
NPI: 1437295664
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SEREDA
FirstName: KATHY
MiddleName: LEA
NamePrefix: MRS.
NameSuffix:  
Credential: BSN RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2191 NOEL CT
Address2:  
City: CHICO
State: CA
PostalCode: 95926
CountryCode: US
TelephoneNumber: 5303429553
FaxNumber:  
Practice Location
Address1: 7200 SKYWAY
Address2:  
City: PARADISE
State: CA
PostalCode: 95969
CountryCode: US
TelephoneNumber: 5308771965
FaxNumber: 5308727784
Other Information
ProviderEnumerationDate: 01/29/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN 384316CAY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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