1760550719 NPI number — CHARLYNN MARIE CUNDY RN, NP

Table of content: CHARLYNN MARIE CUNDY RN, NP (NPI 1760550719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760550719 NPI number — CHARLYNN MARIE CUNDY RN, NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNDY
Provider First Name:
CHARLYNN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHEELER
Provider Other First Name:
CHARLYNN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1760550719
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10725 INTERNATIONAL DR
Provider Second Line Business Mailing Address:
KAISER PERMANENTE WOMEN'S HEALTH
Provider Business Mailing Address City Name:
RANCHO CORDOVA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95670-7967
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-631-3080
Provider Business Mailing Address Fax Number:
916-631-2209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10725 INTERNATIONAL DR
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE WOMEN'S HEALTH
Provider Business Practice Location Address City Name:
RANCHO CORDOVA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95670-7967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-631-3080
Provider Business Practice Location Address Fax Number:
916-631-2209
Provider Enumeration Date:
11/30/2006

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: 363LF0000X , with the licence number:  RN500836, NP13238 , 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: RN500836 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".