1699751271 NPI number — JULIA SWAIN CRNA

Table of content: JULIA SWAIN CRNA (NPI 1699751271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699751271 NPI number — JULIA SWAIN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWAIN
Provider First Name:
JULIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699751271
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4150 V ST
Provider Second Line Business Mailing Address:
PSSB-SUITE 1200, MED: ANESTHESIA
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95817-1460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-734-7985
Provider Business Mailing Address Fax Number:
916-734-2975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4150 V ST
Provider Second Line Business Practice Location Address:
PSSB-SUITE 1200, MED: ANESTHESIA
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817-1460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-7985
Provider Business Practice Location Address Fax Number:
916-734-2975
Provider Enumeration Date:
12/15/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  266589/91 RN/CRNA , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 008269 . This is a "PHYSICIAN INDEX #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".