Provider Demographics
NPI:1871736405
Name:MCCORMICK, HADASSAH LATRESSE (RN)
Entity type:Individual
Prefix:MRS
First Name:HADASSAH
Middle Name:LATRESSE
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7446 COSGROVE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-5214
Mailing Address - Country:US
Mailing Address - Phone:916-393-4557
Mailing Address - Fax:
Practice Address - Street 1:1515 VALDORA ST APT 801
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-7800
Practice Address - Country:US
Practice Address - Phone:916-868-4349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA611638163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse