Provider Demographics
NPI:1164610630
Name:HILL STEGALL, KISHA EUGENA (LVN LICENSE)
Entity Type:Individual
Prefix:MRS
First Name:KISHA
Middle Name:EUGENA
Last Name:HILL STEGALL
Suffix:
Gender:F
Credentials:LVN LICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38239 MULLIGAN DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-8083
Mailing Address - Country:US
Mailing Address - Phone:909-641-8949
Mailing Address - Fax:951-845-6843
Practice Address - Street 1:38239 MULLIGAN DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-8083
Practice Address - Country:US
Practice Address - Phone:909-641-8949
Practice Address - Fax:951-845-6843
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA191598164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse