Provider Demographics
NPI:1982887154
Name:ALFORD, JOAN (PHN)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:ALFORD
Suffix:
Gender:F
Credentials:PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23169 HAWK LN
Mailing Address - Street 2:
Mailing Address - City:TWAIN HARTE
Mailing Address - State:CA
Mailing Address - Zip Code:95383-9744
Mailing Address - Country:US
Mailing Address - Phone:209-586-3414
Mailing Address - Fax:
Practice Address - Street 1:23169 HAWK LN
Practice Address - Street 2:
Practice Address - City:TWAIN HARTE
Practice Address - State:CA
Practice Address - Zip Code:95383-9744
Practice Address - Country:US
Practice Address - Phone:209-586-3414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133035163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management