Provider Demographics
NPI:1114358207
Name:LEDESMA, KRISTINE (MSN, RN)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:LEDESMA
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1584 GREENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-3517
Mailing Address - Country:US
Mailing Address - Phone:619-992-9408
Mailing Address - Fax:
Practice Address - Street 1:1584 GREENFIELD DR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-3517
Practice Address - Country:US
Practice Address - Phone:619-992-9408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA672825163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management