Provider Demographics
NPI:1679383236
Name:BICERA, KYRSTYE BREE ANN (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:KYRSTYE
Middle Name:BREE ANN
Last Name:BICERA
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4960 CEDARBROOK LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-1768
Mailing Address - Country:US
Mailing Address - Phone:951-214-9347
Mailing Address - Fax:
Practice Address - Street 1:4960 CEDARBROOK LN
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-1768
Practice Address - Country:US
Practice Address - Phone:951-214-9347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025579163W00000X
CAL-313254163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse