=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841424066
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUCIA CAROL CARGILL PHD, MSN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2009
-----------------------------------------------------
Last Update Date | 05/01/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | SEQUOIA MIND HEALTH 1506 4TH ST
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-527-1315
-----------------------------------------------------
Fax | 707-527-1307
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | SEQUOIA MIND HEALTH 1506 4TH ST.
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-527-1315
-----------------------------------------------------
Fax | 707-527-1307
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN197365
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | NP18603
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------