Healthcare Provider Details

I. General information

NPI: 1356397426
Provider Name (Legal Business Name): MARJORIE JUNE DOYLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MARJORIE JUNE COOPERIDER RN

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 BROADWAY STE 1100
SACRAMENTO CA
95820
US

IV. Provider business mailing address

824 SENIOR WAY
SACRAMENTO CA
95831-2129
US

V. Phone/Fax

Practice location:
  • Phone: 916-874-2554
  • Fax: 916-874-2717
Mailing address:
  • Phone: 916-391-6196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number160825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: