1922313824 NPI number — DR. BEVERLY ANN NUCHOLS ANP, PHD

Table of content: DR. BEVERLY ANN NUCHOLS ANP, PHD (NPI 1922313824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922313824 NPI number — DR. BEVERLY ANN NUCHOLS ANP, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NUCHOLS
Provider First Name:
BEVERLY
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
ANP, PHD
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:
1922313824
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20103 LAKE CHABOT RD
Provider Second Line Business Mailing Address:
EDEN MEDICAL CENTER EMPLOYEE HEALTH CLINIC
Provider Business Mailing Address City Name:
CASTRO VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94546-5305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-889-5067
Provider Business Mailing Address Fax Number:
510-537-1443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20103 LAKE CHABOT RD
Provider Second Line Business Practice Location Address:
EDEN MEDICAL CENTER EMPLOYEE HEALTH CLINIC
Provider Business Practice Location Address City Name:
CASTRO VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94546-5305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-889-5067
Provider Business Practice Location Address Fax Number:
510-537-1443
Provider Enumeration Date:
08/16/2010

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: 363LA2200X , with the licence number:  257198 , 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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