Healthcare Provider Details

I. General information

NPI: 1417852765
Provider Name (Legal Business Name): RENEE GIPSON LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8666 SUMMER SUN WAY
ELK GROVE CA
95624-1210
US

IV. Provider business mailing address

8666 SUMMER SUN WAY
ELK GROVE CA
95624-1210
US

V. Phone/Fax

Practice location:
  • Phone: 209-480-1260
  • Fax:
Mailing address:
  • Phone: 510-363-0206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number741111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: