1942307673 NPI number — MS. KRISTINE L. JESSEN-MATHER NP #NPF4647

Table of content: MS. KRISTINE L. JESSEN-MATHER NP #NPF4647 (NPI 1942307673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942307673 NPI number — MS. KRISTINE L. JESSEN-MATHER NP #NPF4647

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JESSEN-MATHER
Provider First Name:
KRISTINE
Provider Middle Name:
L.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP #NPF4647
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JESSEN-MATHER
Provider Other First Name:
KRIS
Provider Other Middle Name:
L.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP #NPF4647
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1942307673
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 LITTON DR. #100
Provider Second Line Business Mailing Address:
PO BOX 459001
Provider Business Mailing Address City Name:
GRASS VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-477-4016
Provider Business Mailing Address Fax Number:
530-477-4018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 LITTON DR. #100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRASS VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-477-4016
Provider Business Practice Location Address Fax Number:
530-477-4018
Provider Enumeration Date:
09/17/2006

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: 363LP0200X , with the licence number:  NP 4647 , 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: NP 4647 . This is a "NURSE PRACT. CERTIFICATIO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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