Healthcare Provider Details

I. General information

NPI: 1780110130
Provider Name (Legal Business Name): TERI SEVERSON ELECTROLYSIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 HIGH ST SUITE 201
AUBURN CA
95603-4735
US

IV. Provider business mailing address

701 HIGH ST SUITE 201
AUBURN CA
95603-4735
US

V. Phone/Fax

Practice location:
  • Phone: 916-267-1377
  • Fax:
Mailing address:
  • Phone: 916-267-1377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberL9307
License Number StateCA

VIII. Authorized Official

Name: TERI SEVERSON
Title or Position: SOLE PROPRIETER
Credential: L.E.
Phone: 916-267-1377