Provider Demographics
NPI:1407635097
Name:SHEDDEN, KATHRYN
Entity Type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:
Last Name:SHEDDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45465 25TH ST E SPC 296
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-1003
Mailing Address - Country:US
Mailing Address - Phone:951-577-6803
Mailing Address - Fax:
Practice Address - Street 1:45465 25TH ST E SPC 296
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-1003
Practice Address - Country:US
Practice Address - Phone:951-577-6803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00227135374U00000X
CA00747986376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide