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General NPI Number Information
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NPI Number | 1275869422
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Entity Type | Organization
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Legal Business Name | KAISER PERMANENTE
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Dates
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Enumeration Date | 10/22/2009
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Last Update Date | 10/22/2009
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Provider Practice Location Address
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Address Line | 4601 DALE RD
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City | MODESTO
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State | CA
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Zip | 95356-9718
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Country | US
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Telephone | 209-735-5828
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Fax |
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Provider Business Mailing Address
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Address Line | 4601 DALE RD
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City | MODESTO
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State | CA
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Zip | 95356-9718
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CERTIFIED NURSE MIDWIFE
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Name | MRS. JENNIFER ANN BEARD
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Credential | CNM
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Telephone | 209-735-5828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NW0100X
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Taxonomy Name | Women's Hospital
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License Number | 1851
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License Number State | CA
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