Provider Demographics
NPI:1427354158
Name:UNDERWOOD, LOALEA ELLEN (RN,BSN,PHN)
Entity type:Individual
Prefix:MRS
First Name:LOALEA
Middle Name:ELLEN
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:RN,BSN,PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 OREGANO RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-3976
Mailing Address - Country:US
Mailing Address - Phone:661-836-3148
Mailing Address - Fax:
Practice Address - Street 1:1800 MOUNT VERNON AVE FL 2
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-3302
Practice Address - Country:US
Practice Address - Phone:661-868-0318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA516102163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health