Healthcare Provider Details

I. General information

NPI: 1457804619
Provider Name (Legal Business Name): GRACE ELAINE MCATASNEY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 WEEOT WAY
ARCATA CA
95521-4734
US

IV. Provider business mailing address

1600 WEEOT WAY
ARCATA CA
95521-4734
US

V. Phone/Fax

Practice location:
  • Phone: 707-825-5010
  • Fax: 707-825-6747
Mailing address:
  • Phone: 707-825-5010
  • Fax: 505-368-7011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP02960
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95010826
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95010826
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number511718
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: