Provider Demographics
NPI:1114338027
Name:NORTHERN CALIFORNIA ADVANCED PRACTICE NURSING SERVICES, INC.
Entity Type:Organization
Organization Name:NORTHERN CALIFORNIA ADVANCED PRACTICE NURSING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP-BC
Authorized Official - Phone:707-320-3004
Mailing Address - Street 1:2564 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3641
Mailing Address - Country:US
Mailing Address - Phone:707-320-3004
Mailing Address - Fax:707-224-5848
Practice Address - Street 1:2564 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3641
Practice Address - Country:US
Practice Address - Phone:707-320-3004
Practice Address - Fax:707-224-5848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12604363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12604OtherNP LICENSE
CA431102OtherRN LICENSE