Healthcare Provider Details

I. General information

NPI: 1730567454
Provider Name (Legal Business Name): ANTONIA SCHAEFFER R.N., P.H.N., N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111484 B AVE
AUBURN CA
95630
US

IV. Provider business mailing address

5192 COUNTRYSIDE CT
PLACERVILLE CA
95667-8710
US

V. Phone/Fax

Practice location:
  • Phone: 916-784-6009
  • Fax: 916-784-6464
Mailing address:
  • Phone: 530-621-2206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number222235
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1500
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number1500
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: