Provider Demographics
NPI:1952655623
Name:NEW MILLENNIUM CLINICAL
Entity Type:Organization
Organization Name:NEW MILLENNIUM CLINICAL
Other - Org Name:ESHAAN MEDICAL SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:RONNI
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRAPANESE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:707-455-8210
Mailing Address - Street 1:1001 NUT TREE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-4166
Mailing Address - Country:US
Mailing Address - Phone:707-455-8210
Mailing Address - Fax:
Practice Address - Street 1:1001 NUT TREE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-4166
Practice Address - Country:US
Practice Address - Phone:707-455-8210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty