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General NPI Number Information
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NPI Number | 1063439149
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Entity Type | Organization
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Legal Business Name | NIGHTINGALE MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1414 S MILLER ST SUITE 4
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City | SANTA MARIA
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State | CA
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Zip | 93454-6923
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Country | US
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Telephone | 805-349-6336
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Fax |
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Provider Business Mailing Address
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Address Line | 1414 S MILLER ST SUITE 4
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City | SANTA MARIA
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State | CA
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Zip | 93454-6923
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Country | US
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Telephone | 805-349-6336
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT / NURSE PRACTITIONER
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Name | KAY C MORELAND
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Credential | NP
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Telephone | 805-349-6336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | G045273
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License Number State | CA
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