1588232268 NPI number — MRS. ROSALYN HELENE PYLE RN, PHN

Table of content: MRS. ROSALYN HELENE PYLE RN, PHN (NPI 1588232268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588232268 NPI number — MRS. ROSALYN HELENE PYLE RN, PHN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PYLE
Provider First Name:
ROSALYN
Provider Middle Name:
HELENE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, PHN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOOTH
Provider Other First Name:
ROSALYN
Provider Other Middle Name:
HELENE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588232268
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIPOSA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95338-0005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-966-3689
Provider Business Mailing Address Fax Number:
209-966-4929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5300 HWY 49
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARIPOSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95338-9533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-966-3689
Provider Business Practice Location Address Fax Number:
209-966-3689
Provider Enumeration Date:
06/17/2021

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:  95125920 , 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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