Provider Demographics
NPI:1740303668
Name:ANDEREGG, KATHY R (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:R
Last Name:ANDEREGG
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15421 SANTOS AVE
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-9748
Mailing Address - Country:US
Mailing Address - Phone:209-599-2416
Mailing Address - Fax:
Practice Address - Street 1:1012 RAUBE CT
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-2417
Practice Address - Country:US
Practice Address - Phone:209-544-9377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504002163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health