Provider Demographics
NPI:1811109077
Name:HEALDSBURG UNIFIED SCHOOL DISTRICT
Entity type:Organization
Organization Name:HEALDSBURG UNIFIED SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:707-431-3582
Mailing Address - Street 1:1028 PRINCE AVE
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3449
Mailing Address - Country:US
Mailing Address - Phone:707-431-3488
Mailing Address - Fax:
Practice Address - Street 1:1028 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3449
Practice Address - Country:US
Practice Address - Phone:707-431-3488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS4975390Medicaid