1447214580 NPI number — JANE E EDDY P.A.

Table of content: JANE E EDDY P.A. (NPI 1447214580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447214580 NPI number — JANE E EDDY P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDDY
Provider First Name:
JANE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
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:
1447214580
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38 ROSIER CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95833-3588
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-927-2807
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9352 MADISON AVE
Provider Second Line Business Practice Location Address:
SUITE ONE
Provider Business Practice Location Address City Name:
ORANGEVALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95662-4968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-989-2929
Provider Business Practice Location Address Fax Number:
916-989-0322
Provider Enumeration Date:
04/14/2006

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: 363A00000X , with the licence number:  PA12568 , 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: PA 12568 . This is a "STATE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com