Provider Demographics
NPI:1932262730
Name:PACHECO, EDNA AUDREY (RN)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:AUDREY
Last Name:PACHECO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3449 VALLE VERDE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2414
Mailing Address - Country:US
Mailing Address - Phone:707-226-6668
Mailing Address - Fax:707-226-6699
Practice Address - Street 1:3449 VALLE VERDE DR
Practice Address - Street 2:SUITE C
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2414
Practice Address - Country:US
Practice Address - Phone:707-226-6668
Practice Address - Fax:707-226-6699
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA516738163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN516738OtherRN