Provider Demographics
NPI:1609615517
Name:VIENOLA, ALANIS GABRIELLE (LVN)
Entity type:Individual
Prefix:
First Name:ALANIS
Middle Name:GABRIELLE
Last Name:VIENOLA
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 1:14245 FROST BLVD
Mailing Address - Street 2:
Mailing Address - City:BOULDER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95006-9507
Mailing Address - Country:US
Mailing Address - Phone:831-254-3329
Mailing Address - Fax:
Practice Address - Street 1:526 ROBIN DR
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4716
Practice Address - Country:US
Practice Address - Phone:831-588-4251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA711851164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse