Healthcare Provider Details

I. General information

NPI: 1639640675
Provider Name (Legal Business Name): STEPHANIE ANNE HONDA WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 CREEKSIDE DR
FOLSOM CA
95630-3914
US

IV. Provider business mailing address

1735 CREEKSIDE DR
FOLSOM CA
95630-3914
US

V. Phone/Fax

Practice location:
  • Phone: 916-983-3500
  • Fax:
Mailing address:
  • Phone: 916-983-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1197
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: