1659478360 NPI number — MRS. MELANIE M LEHMAN PA-C

Table of content: MRS. MELANIE M LEHMAN PA-C (NPI 1659478360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659478360 NPI number — MRS. MELANIE M LEHMAN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEHMAN
Provider First Name:
MELANIE
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STOLTZ
Provider Other First Name:
MELANIE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659478360
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3254 PROFESSIONAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95602-2412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-888-1016
Provider Business Mailing Address Fax Number:
530-888-1346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3254 PROFESSIONAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-888-1016
Provider Business Practice Location Address Fax Number:
530-888-1346
Provider Enumeration Date:
09/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA18062 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR0046090 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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