1932271756 NPI number — DR. NANCY HENNING WERES MD

Table of content: DR. NANCY HENNING WERES MD (NPI 1932271756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932271756 NPI number — DR. NANCY HENNING WERES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WERES
Provider First Name:
NANCY
Provider Middle Name:
HENNING
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WERES
Provider Other First Name:
NANCY
Provider Other Middle Name:
HENNING
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932271756
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3539 BRADSHAW RD
Provider Second Line Business Mailing Address:
#321
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95827-3381
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3539 BRADSHAW RD
Provider Second Line Business Practice Location Address:
#321
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95827-3381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-369-8262
Provider Business Practice Location Address Fax Number:
916-369-8262
Provider Enumeration Date:
11/15/2006

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: 208000000X , with the licence number:  G43119 , 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: 00G431190 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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