Provider Demographics
NPI:1770992323
Name:HOUSE, NETTIE (LVN)
Entity type:Individual
Prefix:MS
First Name:NETTIE
Middle Name:
Last Name:HOUSE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17150 SAN MATEO ST
Mailing Address - Street 2:APT D-19
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3669
Mailing Address - Country:US
Mailing Address - Phone:714-962-6806
Mailing Address - Fax:
Practice Address - Street 1:1000 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 110
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-7600
Practice Address - Country:US
Practice Address - Phone:800-350-1323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120349164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse