Provider Demographics
NPI:1558173054
Name:STANDIFER, KENDELL RAE ROGERS
Entity type:Individual
Prefix:
First Name:KENDELL
Middle Name:RAE ROGERS
Last Name:STANDIFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8115 SENECA DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-9116
Mailing Address - Country:US
Mailing Address - Phone:775-276-0938
Mailing Address - Fax:
Practice Address - Street 1:8115 SENECA DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-9116
Practice Address - Country:US
Practice Address - Phone:775-276-0938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV836283163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management