1386719342 NPI number — DONNA SUE MCAULEY FNP CMW

Table of content: DONNA SUE MCAULEY FNP CMW (NPI 1386719342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386719342 NPI number — DONNA SUE MCAULEY FNP CMW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCAULEY
Provider First Name:
DONNA
Provider Middle Name:
SUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP CMW
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:
1386719342
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
686 W LINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BISHOP
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93514-3315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-872-4311
Provider Business Mailing Address Fax Number:
760-872-4130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
686 W LINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BISHOP
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93514-3315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-872-4311
Provider Business Practice Location Address Fax Number:
760-872-4130
Provider Enumeration Date:
11/22/2006

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: 363L00000X , with the licence number:  5783 , 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: 00C371720 . This is a "BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 366 . This is a "NURSE MIDWIFE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00C371720 . This is a "BLUE SHEILD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 201575 . This is a "REGISTERED NURSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0021672 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5783 . This is a "NURSE PRACTITIONER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 770051426001 . This is a "TRICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: RHM53941F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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