Healthcare Provider Details

I. General information

NPI: 1679248199
Provider Name (Legal Business Name): KATRINA ANNE ENGSTROM FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 TRAVIS BLVD STE C
FAIRFIELD CA
94533-4611
US

IV. Provider business mailing address

1325 TRAVIS BLVD STE C
FAIRFIELD CA
94533-4611
US

V. Phone/Fax

Practice location:
  • Phone: 707-429-8855
  • Fax:
Mailing address:
  • Phone: 925-887-5398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: