1750354833 NPI number — DEANNA MARIE KARLSTAD CRNP

Table of content: DEANNA MARIE KARLSTAD CRNP (NPI 1750354833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750354833 NPI number — DEANNA MARIE KARLSTAD CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARLSTAD
Provider First Name:
DEANNA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARKS
Provider Other First Name:
DEANNA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750354833
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3400 DATA DRIVE
Provider Second Line Business Mailing Address:
CREDENTIALING DEPARTMENT, 1ST FLOOR
Provider Business Mailing Address City Name:
RANCHO CORDOVA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95670-7956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-784-8070
Provider Business Mailing Address Fax Number:
916-784-7509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2110 PROFESSIONAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95661-3779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-536-2500
Provider Business Practice Location Address Fax Number:
916-780-3904
Provider Enumeration Date:
02/09/2006

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: 363LF0000X , with the licence number:  15801 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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