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General NPI Number Information
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NPI Number | 1669687182
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Entity Type | Individual
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Provider Name | NANCY LAYBOURN P.A.
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Gender | Female
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1050 N STATE ST
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City | UKIAH
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State | CA
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Zip | 95482-3414
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Country | US
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Telephone | 707-746-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 10691 MAIN STREET
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City | POTTER VALLEY
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State | CA
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Zip | 95469
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Country | US
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Telephone | 707-743-1267
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 11696
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License Number State | CA
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