Healthcare Provider Details

I. General information

NPI: 1376543819
Provider Name (Legal Business Name): JEAN MARIE TURNER DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7005 HAZEL COTTER CT
SEBASTOPOL CA
95472-4554
US

IV. Provider business mailing address

7005 HAZEL COTTER CT
SEBASTOPOL CA
95472-4554
US

V. Phone/Fax

Practice location:
  • Phone: 707-823-4325
  • Fax: 707-823-4975
Mailing address:
  • Phone: 707-823-4325
  • Fax: 707-823-4975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE2987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: