Provider Demographics
NPI:1073796793
Name:HARDER, KENDRA MARIE (LVN)
Entity Type:Individual
Prefix:MISS
First Name:KENDRA
Middle Name:MARIE
Last Name:HARDER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3426
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95967-3426
Mailing Address - Country:US
Mailing Address - Phone:530-876-1069
Mailing Address - Fax:
Practice Address - Street 1:1090 SHADOWBROOK WAY
Practice Address - Street 2:APT#33
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4756
Practice Address - Country:US
Practice Address - Phone:530-876-1069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN191932164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse