1982738027 NPI number — MRS. BLAIR CHRISTINE MCANELLY

Table of content: MRS. BLAIR CHRISTINE MCANELLY (NPI 1982738027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982738027 NPI number — MRS. BLAIR CHRISTINE MCANELLY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCANELLY
Provider First Name:
BLAIR
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
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:
1982738027
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 EAST ST
Provider Second Line Business Mailing Address:
SUITE 123
Provider Business Mailing Address City Name:
WOODLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95776-4976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-668-6767
Provider Business Mailing Address Fax Number:
530-668-4010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 EAST ST
Provider Second Line Business Practice Location Address:
SUITE 123
Provider Business Practice Location Address City Name:
WOODLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95776-4976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-668-6767
Provider Business Practice Location Address Fax Number:
530-668-4010
Provider Enumeration Date:
03/14/2007

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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