Provider Demographics
NPI:1881848232
Name:MANSON, DORINDA ELAINE (NURSE LVN 83466)
Entity Type:Individual
Prefix:MRS
First Name:DORINDA
Middle Name:ELAINE
Last Name:MANSON
Suffix:
Gender:F
Credentials:NURSE LVN 83466
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16400 RANCHO TEHAMA RD.
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:CA
Mailing Address - Zip Code:96021-5532
Mailing Address - Country:US
Mailing Address - Phone:530-585-2395
Mailing Address - Fax:
Practice Address - Street 1:1716 COURT ST STE B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1762
Practice Address - Country:US
Practice Address - Phone:530-223-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN83466164X00000X
CA16164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse