Provider Demographics
NPI:1356424295
Name:WEBBER, CONNIE SUE (RN)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:SUE
Last Name:WEBBER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:CONNIE
Other - Middle Name:SUE
Other - Last Name:WHITWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4804 RHONDA RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007-9006
Mailing Address - Country:US
Mailing Address - Phone:530-365-1489
Mailing Address - Fax:
Practice Address - Street 1:1860 WALNUT ST
Practice Address - Street 2:SUITE A
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-3611
Practice Address - Country:US
Practice Address - Phone:530-527-5631
Practice Address - Fax:530-527-0232
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN431307163WA2000X, 163WP0808X, 163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Not Answered163WR0400XNursing Service ProvidersRegistered NurseRehabilitation