Healthcare Provider Details

I. General information

NPI: 1760812499
Provider Name (Legal Business Name): PACIFIC OB-GYN, MIDWIFERY & NURSING CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 WALFORD AVE STE B
EUREKA CA
95503-4828
US

IV. Provider business mailing address

3200 WALFORD AVE # B
EUREKA CA
95503-4828
US

V. Phone/Fax

Practice location:
  • Phone: 707-445-3443
  • Fax: 707-445-1848
Mailing address:
  • Phone: 707-498-8022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH W O BRIEN
Title or Position: PRESIDENT
Credential: NP, RN, NPF, MIDWIFE
Phone: 707-498-8022