1649216599 NPI number — MARGARET ELLEN VANDERKAR MFT

Table of content: MARGARET ELLEN VANDERKAR MFT (NPI 1649216599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649216599 NPI number — MARGARET ELLEN VANDERKAR MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANDERKAR
Provider First Name:
MARGARET
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VANDERKAR
Provider Other First Name:
PEG
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1649216599
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
504 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DIAMOND SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95619-9109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-295-1230
Provider Business Mailing Address Fax Number:
530-626-8117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
504 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DIAMOND SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95619-9109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-295-1230
Provider Business Practice Location Address Fax Number:
530-626-8117
Provider Enumeration Date:
06/21/2006

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: 106H00000X , with the licence number:  MFC36397 , 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)