=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578187571
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARACELI AMANO STOYKOVICH NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2020
-----------------------------------------------------
Last Update Date | 12/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2450 ORO DAM BLVD E
-----------------------------------------------------
City | OROVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95966-6052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-712-2171
-----------------------------------------------------
Fax | 530-712-2149
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5040
-----------------------------------------------------
City | OROVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95966-0040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-712-2171
-----------------------------------------------------
Fax | 530-712-2149
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 95016269
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 95082806
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------