1285797480 NPI number — ELIZABETH MARGARET WILDENHAUS MHC

Table of content: ELIZABETH MARGARET WILDENHAUS MHC (NPI 1285797480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285797480 NPI number — ELIZABETH MARGARET WILDENHAUS MHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILDENHAUS
Provider First Name:
ELIZABETH
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MHC
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:
1285797480
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:
PO BOX 87
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMILTON CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95951-0087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-895-6614
Provider Business Mailing Address Fax Number:
530-895-6669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 COHASSET ROAD
Provider Second Line Business Practice Location Address:
SUITE 15
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:
530-891-2945
Provider Business Practice Location Address Fax Number:
530-895-6669
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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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