Provider Demographics
NPI:1043469265
Name:ALDRICH, THERESA SUE (LVN)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:SUE
Last Name:ALDRICH
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 1:462 NEWHALL DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-1028
Mailing Address - Country:US
Mailing Address - Phone:951-808-0212
Mailing Address - Fax:
Practice Address - Street 1:24869 RIVER OAK CT
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7704
Practice Address - Country:US
Practice Address - Phone:951-696-1980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN217130164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse