Provider Demographics
NPI:1730392184
Name:EYMANN, GWENDOLYN P (RN-NP)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:P
Last Name:EYMANN
Suffix:
Gender:F
Credentials:RN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CATHERINE LN
Mailing Address - Street 2:SUITE F
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5719
Mailing Address - Country:US
Mailing Address - Phone:530-274-6175
Mailing Address - Fax:530-274-6234
Practice Address - Street 1:150 CATHERINE LN
Practice Address - Street 2:SUITE F
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5719
Practice Address - Country:US
Practice Address - Phone:530-274-6175
Practice Address - Fax:530-274-6234
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5458NP363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP401050FMedicaid
CA050150Medicare ID - Type UnspecifiedMEDICARE PROVIDER