Healthcare Provider Details

I. General information

NPI: 1336280734
Provider Name (Legal Business Name): MARTA ELIZABETH PREUSSER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WOOD ST
EUREKA CA
95501-4413
US

IV. Provider business mailing address

1662 VERNON ST
EUREKA CA
95501-1439
US

V. Phone/Fax

Practice location:
  • Phone: 707-445-7710
  • Fax: 707-476-4061
Mailing address:
  • Phone: 707-444-9756
  • Fax: 707-476-4061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number546518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: