Healthcare Provider Details

I. General information

NPI: 1699803114
Provider Name (Legal Business Name): MS. THERESA LYNN LEDGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 N KAWEAH AVE # 516
EXETER CA
93221-1200
US

IV. Provider business mailing address

514 N KAWEAH AVE # 516
EXETER CA
93221-1200
US

V. Phone/Fax

Practice location:
  • Phone: 559-594-4969
  • Fax: 559-594-4308
Mailing address:
  • Phone: 559-594-4969
  • Fax: 559-594-4308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: