Healthcare Provider Details

I. General information

NPI: 1558227934
Provider Name (Legal Business Name): CHRISTINE ANN WEITNAUER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 DEL CAMPO LN
CARMICHAEL CA
95608-0124
US

IV. Provider business mailing address

8715 FREESIA DR
ELK GROVE CA
95624-3825
US

V. Phone/Fax

Practice location:
  • Phone: 916-835-9538
  • Fax:
Mailing address:
  • Phone: 916-835-9538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number719203
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: