=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114338027
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHERN CALIFORNIA ADVANCED PRACTICE NURSING SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2014
-----------------------------------------------------
Last Update Date | 07/31/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2564 EDGEWATER DR
-----------------------------------------------------
City | NAPA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94558-3641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-320-3004
-----------------------------------------------------
Fax | 707-224-5848
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2564 EDGEWATER DR
-----------------------------------------------------
City | NAPA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94558-3641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-320-3004
-----------------------------------------------------
Fax | 707-224-5848
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | VICKI D. MOORE
-----------------------------------------------------
Credential | ACNP-BC
-----------------------------------------------------
Telephone | 707-320-3004
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 12604
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------