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General NPI Number Information
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NPI Number | 1144619032
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Entity Type | Organization
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Legal Business Name | N ORTHCOAST WOMENS'S HEALTH
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Dates
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Enumeration Date | 01/15/2015
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Last Update Date | 02/04/2015
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Provider Practice Location Address
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Address Line | 1930 MYRTLE AVE
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City | EUREKA
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State | CA
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Zip | 95501-1406
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Country | US
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Telephone | 707-825-3369
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Fax |
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Provider Business Mailing Address
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Address Line | 579 HIDDEN VALLEY RD
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City | BAYSIDE
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State | CA
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Zip | 95524-9049
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Country | US
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Telephone | 707-601-4687
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Fax |
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Authorized Official
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Title or Position | RN OB GYN NP
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Name | MS. MARCIA JANE BRENTA
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Credential | OB GYN NP
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Telephone | 707-601-4687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0005X
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Taxonomy Name | Ambulatory Family Planning Facility
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License Number | 262859
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License Number State | CA
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