Healthcare Provider Details

I. General information

NPI: 1366933939
Provider Name (Legal Business Name): VIRGINA LOUISE AHRENHOLTZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIRGINIA L MITCHELL RN

II. Dates (important events)

Enumeration Date: 05/19/2018
Last Update Date: 05/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 GLASSON WAY
GRASS VALLEY CA
95945-5723
US

IV. Provider business mailing address

1422 VISTA AVE
NAPA CA
94559-1502
US

V. Phone/Fax

Practice location:
  • Phone: 530-470-2425
  • Fax: 530-265-7027
Mailing address:
  • Phone: 707-718-7684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number743265
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: