Provider Demographics
NPI:1669837456
Name:NANALIS, RHODALYN
Entity Type:Individual
Prefix:
First Name:RHODALYN
Middle Name:
Last Name:NANALIS
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 1:24578 MONTEVISTA CIR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1226
Mailing Address - Country:US
Mailing Address - Phone:661-373-0543
Mailing Address - Fax:
Practice Address - Street 1:24578 MONTEVISTA CIR
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91354-1226
Practice Address - Country:US
Practice Address - Phone:661-373-0543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003304363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily