Provider Demographics
NPI:1083837264
Name:VICKERS, ASSUNTA MARIA (RN, PHN)
Entity Type:Individual
Prefix:MS
First Name:ASSUNTA
Middle Name:MARIA
Last Name:VICKERS
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 CLOUDCREST WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-3027
Mailing Address - Country:US
Mailing Address - Phone:951-788-7932
Mailing Address - Fax:
Practice Address - Street 1:164 W HOSPITALITY LN STE 3
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3328
Practice Address - Country:US
Practice Address - Phone:909-379-1505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA333687163WA0400X, 163WC0400X, 163WC1500X, 163WH0200X, 163WI0500X, 163WM0102X
CA33687163WN0003X, 163WP0200X, 163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
Not Answered163WC0400XNursing Service ProvidersRegistered NurseCase Management
Not Answered163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome Health
Not Answered163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
Not Answered163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
Not Answered163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk
Not Answered163WP0200XNursing Service ProvidersRegistered NursePediatrics
Not Answered163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent