1962773580 NPI number — TARYL LYNN NOTHERN NP

Table of content: TARYL LYNN NOTHERN NP (NPI 1962773580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962773580 NPI number — TARYL LYNN NOTHERN NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOTHERN
Provider First Name:
TARYL
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1962773580
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 S ANAHEIM HILLS ROAD
Provider Second Line Business Mailing Address:
SUITE 129
Provider Business Mailing Address City Name:
ANAHEIM HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-282-1892
Provider Business Mailing Address Fax Number:
714-282-9682

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 S ANAHEIM HILLS ROAD
Provider Second Line Business Practice Location Address:
SUITE 129
Provider Business Practice Location Address City Name:
ANAHEIM HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-282-1892
Provider Business Practice Location Address Fax Number:
714-282-9682
Provider Enumeration Date:
01/13/2012

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: 163W00000X , with the licence number:  361783 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 8007 , 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)