Provider Demographics
NPI:1245368653
Name:A.WHITEBREAD RNFA
Entity type:Organization
Organization Name:A.WHITEBREAD RNFA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE FIRST ASSIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WHITEBREAD
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA
Authorized Official - Phone:209-872-6316
Mailing Address - Street 1:1702 SANDALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-3819
Mailing Address - Country:US
Mailing Address - Phone:209-872-6316
Mailing Address - Fax:
Practice Address - Street 1:1702 SANDALWOOD DR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-3819
Practice Address - Country:US
Practice Address - Phone:209-872-6316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA411562282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital