Healthcare Provider Details

I. General information

NPI: 1982932992
Provider Name (Legal Business Name): STACIE NICOLE THUM MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 EMBARCADERO DR STE 2
EL DORADO HILLS CA
95762-1400
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 916-458-5533
  • Fax: 916-458-5549
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number596102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: