1144390550 NPI number — PERSIMMON, A CENTER FOR HEALING ACUPUNCTURE CORPORATION

Table of content: MS. KIMBERLY LYNN KOLLMEYER MFTI (NPI 1831243617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144390550 NPI number — PERSIMMON, A CENTER FOR HEALING ACUPUNCTURE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERSIMMON, A CENTER FOR HEALING ACUPUNCTURE CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1144390550
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
820 GRAVENSTEIN AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SEBASTOPOL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95472-4557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-823-8903
Provider Business Mailing Address Fax Number:
707-676-8688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 GRAVENSTEIN AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SEBASTOPOL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95472-4557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-823-8903
Provider Business Practice Location Address Fax Number:
707-676-8688
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHLESINGER
Authorized Official First Name:
RUTH
Authorized Official Middle Name:
ESTHER
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
707-823-8903

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC 7634 , 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)





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