1487650321 NPI number — ANNE S CARLISLE FNP-C

Table of content: ANNE S CARLISLE FNP-C (NPI 1487650321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487650321 NPI number — ANNE S CARLISLE FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARLISLE
Provider First Name:
ANNE
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
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:
1487650321
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2107 AIRPARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDDING
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96001-2433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-241-7098
Provider Business Mailing Address Fax Number:
530-241-1483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 2ND ST
Provider Second Line Business Practice Location Address:
SUITE 219
Provider Business Practice Location Address City Name:
EUREKA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95501-5107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-444-1331
Provider Business Practice Location Address Fax Number:
707-444-1369
Provider Enumeration Date:
06/24/2005

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: 363L00000X , with the licence number:  NP8560 , 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: NP8560 . This is a "FNP LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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