Healthcare Provider Details

I. General information

NPI: 1437129269
Provider Name (Legal Business Name): JEANNETTE BINGHAM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4663 SCOTTS VALLEY DR
SCOTTS VALLEY CA
95066-4202
US

IV. Provider business mailing address

2350 W EL CAMINO REAL 2ND FLOOR
MOUNTAIN VIEW CA
94040-6201
US

V. Phone/Fax

Practice location:
  • Phone: 831-458-6330
  • Fax:
Mailing address:
  • Phone: 707-303-6424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP12937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: