Provider Demographics
NPI:1447214580
Name:EDDY, JANE E (PA)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:E
Last Name:EDDY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 ROSIER CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-3588
Mailing Address - Country:US
Mailing Address - Phone:916-927-2807
Mailing Address - Fax:
Practice Address - Street 1:9352 MADISON AVE
Practice Address - Street 2:SUITE ONE
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-4968
Practice Address - Country:US
Practice Address - Phone:916-989-2929
Practice Address - Fax:916-989-0322
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12568363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA 12568OtherSTATE LICENSE
CAME1174236OtherDEA CONTROLLED SUBSTANCE
CAE57223Medicare UPIN