Provider Demographics
NPI:1073293940
Name:LADA, KIRSTIE
Entity Type:Individual
Prefix:
First Name:KIRSTIE
Middle Name:
Last Name:LADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 W GLADSTONE ST APT F
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5500
Mailing Address - Country:US
Mailing Address - Phone:626-216-4369
Mailing Address - Fax:
Practice Address - Street 1:459 W GLADSTONE ST APT F
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5500
Practice Address - Country:US
Practice Address - Phone:626-216-4369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN95270569163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency