Provider Demographics
NPI:1952630006
Name:ANDERSON, JOYCE E (RNFA)
Entity Type:Individual
Prefix:MISS
First Name:JOYCE
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1445
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:CA
Mailing Address - Zip Code:92325-1445
Mailing Address - Country:US
Mailing Address - Phone:909-380-5253
Mailing Address - Fax:909-589-0273
Practice Address - Street 1:22 CORPORATE PLAZA DR
Practice Address - Street 2:SUITE 150
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7985
Practice Address - Country:US
Practice Address - Phone:949-515-0708
Practice Address - Fax:949-515-4497
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA444573163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689864365OtherHOAG HOSPITAL