1275558108 NPI number — VONDA KAY TREAT NP

Table of content: SHAVONNE LEWIS RN (NPI 1437320777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275558108 NPI number — VONDA KAY TREAT NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TREAT
Provider First Name:
VONDA
Provider Middle Name:
KAY
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:
TREAT
Provider Other First Name:
VONDA
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1275558108
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1976 INEZ CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUBA CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95993-6081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-673-1395
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4941 OLIVEHURST AVE
Provider Second Line Business Practice Location Address:
STE 600
Provider Business Practice Location Address City Name:
OLIVEHURST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95961-4225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-743-4611
Provider Business Practice Location Address Fax Number:
530-743-5770
Provider Enumeration Date:
07/13/2006

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: 363L00000X , with the licence number:  8253 , 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: 8253 . This is a "LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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