Provider Demographics
NPI:1093999047
Name:SODERSTROM, MONICA EAST (RN, PHN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:EAST
Last Name:SODERSTROM
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 1:695 OLEANDER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3924
Mailing Address - Country:US
Mailing Address - Phone:530-891-2869
Mailing Address - Fax:530-879-3309
Practice Address - Street 1:695 OLEANDER AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3924
Practice Address - Country:US
Practice Address - Phone:530-891-2869
Practice Address - Fax:530-879-3309
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3907052083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine