Vredenburg, Mary Jane
Vredenburg, Mary Jane is an individual health care provider with primary practice located at 1235 W Vine St Suite 20, Lodi CA 95240-5144. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Vredenburg, Mary Jane can be contacted via phone (209) 339-7600.Contact Information
Primary practice address
1235 W Vine St Suite 20
Lodi CA 95240-5144
Phone: (209) 339-7600
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 20A7374 | California |
Profile Details
| NPI number | 1528025988 |
|---|---|
| LBN Legal business name | Vredenburg, Mary Jane |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 28th, 2006 |
| Last updated | Feb 5th, 2009 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1528025988 | NPPES |
| California | MEDICAID | 00AX73740 |
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