1992703375 NPI number — DR. JOYCE R MILLSPAW PHD, FNP,WHNP, HHNP

Table of content: DR. JOYCE R MILLSPAW PHD, FNP,WHNP, HHNP (NPI 1992703375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992703375 NPI number — DR. JOYCE R MILLSPAW PHD, FNP,WHNP, HHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLSPAW
Provider First Name:
JOYCE
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, FNP,WHNP, HHNP
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:
1992703375
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:
1874 PONTIAC ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95361-3382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-847-7759
Provider Business Mailing Address Fax Number:
209-848-0732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
190 S OAK AVE
Provider Second Line Business Practice Location Address:
BLDG1 STE 4
Provider Business Practice Location Address City Name:
OAKDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95361-3528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-848-8410
Provider Business Practice Location Address Fax Number:
209-848-0732
Provider Enumeration Date:
07/11/2005

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: 363LF0000X , with the licence number:  NPF 2597/322954 , 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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