Provider Demographics
NPI:1841478609
Name:PRESTON, KEITH EDWARD (RN PHN BA)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:EDWARD
Last Name:PRESTON
Suffix:
Gender:M
Credentials:RN PHN BA
Other - Prefix:
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Mailing Address - Street 1:137 N COTTONWOOD ST
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-6646
Mailing Address - Country:US
Mailing Address - Phone:530-666-8333
Mailing Address - Fax:530-666-1283
Practice Address - Street 1:648 41ST ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-2736
Practice Address - Country:US
Practice Address - Phone:530-666-8333
Practice Address - Fax:530-666-1283
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA710116163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse