1215147244 NPI number — MS. CAROLYN LOUISE WEATHERUP LICENSED MARRIAGE

Table of content: MS. CAROLYN LOUISE WEATHERUP LICENSED MARRIAGE (NPI 1215147244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215147244 NPI number — MS. CAROLYN LOUISE WEATHERUP LICENSED MARRIAGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEATHERUP
Provider First Name:
CAROLYN
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICENSED MARRIAGE
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:
1215147244
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 6TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARYSVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-741-6275
Provider Business Mailing Address Fax Number:
530-749-7913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 6TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARYSVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-741-6275
Provider Business Practice Location Address Fax Number:
530-749-7913
Provider Enumeration Date:
05/22/2007

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:  MFC39648 , 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)





Copyright © 2007-2025 www.npivalidator.com