Healthcare Provider Details

I. General information

NPI: 1720930779
Provider Name (Legal Business Name): HOLLY CHASTAIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6826 BROOKHAVEN WAY
CITRUS HEIGHTS CA
95621-6306
US

IV. Provider business mailing address

6826 BROOKHAVEN WAY
CITRUS HEIGHTS CA
95621-6306
US

V. Phone/Fax

Practice location:
  • Phone: 916-718-6749
  • Fax:
Mailing address:
  • Phone: 916-718-6749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95040208
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: