Healthcare Provider Details

I. General information

NPI: 1437219326
Provider Name (Legal Business Name): MARGARET CONLEY TADANO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 COURAGE DR MS 10-100
FAIRFIELD CA
94533-0677
US

IV. Provider business mailing address

142 KERRY CT
VACAVILLE CA
95687-5112
US

V. Phone/Fax

Practice location:
  • Phone: 707-784-2010
  • Fax:
Mailing address:
  • Phone: 707-447-6458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number414462
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: