1366933939 NPI number — MRS. VIRGINA LOUISE AHRENHOLTZ RN

Table of content: MRS. VIRGINA LOUISE AHRENHOLTZ RN (NPI 1366933939)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366933939 NPI number — MRS. VIRGINA LOUISE AHRENHOLTZ RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHRENHOLTZ
Provider First Name:
VIRGINA
Provider Middle Name:
LOUISE
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:
MITCHELL
Provider Other First Name:
VIRGINIA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366933939
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1422 VISTA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94559-1502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-718-7684
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 GLASSON WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRASS VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95945-5723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-470-2425
Provider Business Practice Location Address Fax Number:
530-265-7027
Provider Enumeration Date:
05/19/2018

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: 163WP0809X , with the licence number:  743265 , 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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