1689660318 NPI number — MRS. YVONNE EMILY JACKSON FNP

Table of content: MR. CHRISTOPHER NACCARELLI LCSW (NPI 1801258421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689660318 NPI number — MRS. YVONNE EMILY JACKSON FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACKSON
Provider First Name:
YVONNE
Provider Middle Name:
EMILY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1689660318
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2145 5TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OROVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95965-5870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-534-5394
Provider Business Mailing Address Fax Number:
530-534-3820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1445 VETERANS MEMORIAL CIRCLE
Provider Second Line Business Practice Location Address:
SUTTER COUNTY HEALTH DEPT CLINIC
Provider Business Practice Location Address City Name:
YUBA CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95993
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-822-7240
Provider Business Practice Location Address Fax Number:
530-822-7105
Provider Enumeration Date:
09/27/2005

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:  RN217802 , 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: RN217802 . This is a "LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4782 . This is a "NPF" identifier . This identifiers is of the category "OTHER".