Provider Demographics
NPI:1316360761
Name:VANDENDRIESCHE, ELISE MARIE (RN, PHN)
Entity Type:Individual
Prefix:MS
First Name:ELISE
Middle Name:MARIE
Last Name:VANDENDRIESCHE
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 1:11484 B AVENUE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603
Mailing Address - Country:US
Mailing Address - Phone:530-889-7165
Mailing Address - Fax:530-889-7198
Practice Address - Street 1:11484 B AVENUE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603
Practice Address - Country:US
Practice Address - Phone:530-889-7165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN843949163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management