Provider Demographics
NPI:1134645377
Name:CRONIN, ELIZABETH DIANE (LVN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DIANE
Last Name:CRONIN
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 1:7043 WILSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-4241
Mailing Address - Country:US
Mailing Address - Phone:916-225-5872
Mailing Address - Fax:
Practice Address - Street 1:7043 WILSHIRE CIR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-4241
Practice Address - Country:US
Practice Address - Phone:916-225-5872
Practice Address - Fax:916-225-5872
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN686907164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse