Healthcare Provider Details

I. General information

NPI: 1750354833
Provider Name (Legal Business Name): DEANNA MARIE KARLSTAD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEANNA MARIE MARKS

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 COYLE AVE STE 341
CARMICHAEL CA
95608-0303
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 916-536-2400
  • Fax: 916-536-2431
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: