Provider Demographics
NPI:1487726550
Name:VIERRA, ELEANOR C (RN NPC)
Entity type:Individual
Prefix:MS
First Name:ELEANOR
Middle Name:C
Last Name:VIERRA
Suffix:
Gender:F
Credentials:RN NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DRIVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-564-3040
Mailing Address - Fax:916-564-3065
Practice Address - Street 1:3941 J ST
Practice Address - Street 2:STE 260
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819
Practice Address - Country:US
Practice Address - Phone:916-736-2323
Practice Address - Fax:916-564-3091
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP15768207RC0000X
CA15768363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ47673ZOtherBLUE SHIELD
CAGR0068230Medicaid
CAGR0068233Medicaid
CAP00301682OtherRAILROAD MEDICARE
CAZZZ47675ZOtherBLUE SHIELD
CAGR0068231Medicaid
CAGR0068232Medicaid
CAZZZ47676ZOtherBLUE SHIELD
CAGR0068235Medicaid
CAGR006823BMedicaid
CAZZZ62306ZOtherBLUE SHIELD
CARN378972Medicaid
CAZZZ00968ZMedicare PIN
CAGR0068235Medicaid
CAZZZ00966ZMedicare PIN
CAZZZ47676ZOtherBLUE SHIELD
CAZZZ62306ZOtherBLUE SHIELD
CAZZZ03699ZMedicare ID - Type Unspecified
CAP00301682OtherRAILROAD MEDICARE
Q64136Medicare UPIN