Provider Demographics
NPI:1700246303
Name:LALLY-ARENA, KATHLEEN BRIDGET (R, MSN, FNP, NCSN)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:BRIDGET
Last Name:LALLY-ARENA
Suffix:
Gender:F
Credentials:R, MSN, FNP, NCSN
Other - Prefix:
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Mailing Address - Street 1:5185 STEVENS CIR
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4921
Mailing Address - Country:US
Mailing Address - Phone:310-866-7237
Mailing Address - Fax:310-636-8221
Practice Address - Street 1:5400 BALBOA BL SUITE 103
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316
Practice Address - Country:US
Practice Address - Phone:310-866-7237
Practice Address - Fax:310-636-8221
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP11205363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily