Provider Demographics
NPI:1942488291
Name:PRIMARY CARE NURSES 2000 FAMILY PRACTICE PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PRIMARY CARE NURSES 2000 FAMILY PRACTICE PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWINA
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:HANNA-REESE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:707-554-4704
Mailing Address - Street 1:1860 LANDMARK DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-3852
Mailing Address - Country:US
Mailing Address - Phone:707-554-4704
Mailing Address - Fax:707-552-3288
Practice Address - Street 1:1860 LANDMARK DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-3852
Practice Address - Country:US
Practice Address - Phone:707-554-4704
Practice Address - Fax:707-552-3288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP11850251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP34364Medicare UPIN
CAWNP11850AMedicare PIN