MEDICARE: PAMELA P VISATHEP FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	11998	CA
2	363LA2200X	Adult Health Nurse Practitioner	11998	CA
3	363LF0000X	Family Nurse Practitioner	11998	CA

General Provider Information

NPI Number	:	1407828544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA P VISATHEP FNP

Provider Business Mailing Address
First Line	:	1600 CREEKSIDE DR
Second Line	:	SUITE 3800
City	:	FOLSOM
State	:	CA
Zip	:	95630-3444
Country	:	US
Telephone Number	:	916-984-7830
Fax Number	:	916-984-7887

Provider Business Practice Location Address
First Line	:	1600 CREEKSIDE DR
Second Line	:	SUITE 3800
City	:	FOLSOM
State	:	CA
Zip	:	95630-3444
Country	:	US
Telephone Number	:	916-984-7830
Fax Number	:	916-984-7887

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	12/30/2016

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