Healthcare Provider Details

I. General information

NPI: 1366582025
Provider Name (Legal Business Name): DESIREE CONIGLIO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DESIREE CRYTS

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11670 ATWOOD RD
AUBURN CA
95603-9522
US

IV. Provider business mailing address

11670 ATWOOD RD
AUBURN CA
95603-9522
US

V. Phone/Fax

Practice location:
  • Phone: 530-887-2800
  • Fax:
Mailing address:
  • Phone: 530-887-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number14116330101
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number733034
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number143094
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number143100
License Number StateKS
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5375505101
License Number StateKS
# 7
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95008957
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: