Provider Demographics
NPI:1093830465
Name:DEMAREE, VIVIAN WILMA (RN, BSN,PHN)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:WILMA
Last Name:DEMAREE
Suffix:
Gender:F
Credentials:RN, BSN,PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 PINA LN
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-5931
Mailing Address - Country:US
Mailing Address - Phone:760-758-1831
Mailing Address - Fax:
Practice Address - Street 1:104 BARNES ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-3406
Practice Address - Country:US
Practice Address - Phone:760-966-3806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA246037163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health