1134282601 NPI number — MRS. BROOKE LEANNE REGINELLI RN

Table of content: MRS. BROOKE LEANNE REGINELLI RN (NPI 1134282601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134282601 NPI number — MRS. BROOKE LEANNE REGINELLI RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REGINELLI
Provider First Name:
BROOKE
Provider Middle Name:
LEANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OSBURN
Provider Other First Name:
BROOKE
Provider Other Middle Name:
LEANNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134282601
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:
47 SKYWALKER CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95973
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-588-3420
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 PARMAC ROAD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-891-2784
Provider Business Practice Location Address Fax Number:
530-891-2809
Provider Enumeration Date:
12/18/2006

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: 163W00000X , with the licence number:  RN640770 , 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: RN640770 . This is a "LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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