Provider Demographics
NPI:1144619032
Name:N ORTHCOAST WOMENS'S HEALTH
Entity Type:Organization
Organization Name:N ORTHCOAST WOMENS'S HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN OB GYN NP
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:BRENTA
Authorized Official - Suffix:
Authorized Official - Credentials:OB GYN NP
Authorized Official - Phone:707-601-4687
Mailing Address - Street 1:579 HIDDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:95524-9049
Mailing Address - Country:US
Mailing Address - Phone:707-601-4687
Mailing Address - Fax:
Practice Address - Street 1:1930 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1406
Practice Address - Country:US
Practice Address - Phone:707-825-3369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA262859261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility