=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437375946
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY WEGMANN RIFFLE RN NP NURSE PRACTITI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1101 WELCH RD A8
-----------------------------------------------------
City | PALO ALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-329-1293
-----------------------------------------------------
Fax | 650-329-1317
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 935 WILMINGTON WAY
-----------------------------------------------------
City | EMERALD HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-364-6938
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | 245604
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------