Provider Demographics
NPI:1568581593
Name:ANDRADE, JESSIE A (LVN)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:A
Last Name:ANDRADE
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:YCADMH 137 N.COTTONWOOD
Mailing Address - Street 2:SUITE 1520
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695
Mailing Address - Country:US
Mailing Address - Phone:530-666-8630
Mailing Address - Fax:
Practice Address - Street 1:137 NO. COTTONWOOD ST.
Practice Address - Street 2:SUITE 1520
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695
Practice Address - Country:US
Practice Address - Phone:530-666-8630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN23796164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse