Provider Demographics
NPI:1346668910
Name:BATESOLE, TASHA SHARIE (RN)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:SHARIE
Last Name:BATESOLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:SHARIE
Other - Last Name:HODGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2134 SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6147
Mailing Address - Country:US
Mailing Address - Phone:559-408-4790
Mailing Address - Fax:
Practice Address - Street 1:2134 SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6147
Practice Address - Country:US
Practice Address - Phone:559-408-4790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA777674163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse