Healthcare Provider Details

I. General information

NPI: 1508717257
Provider Name (Legal Business Name): STEPHANIE MASSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 SUNRISE BLVD STE A
GOLD RIVER CA
95670-4344
US

IV. Provider business mailing address

8095 DICK COOK RD
LOOMIS CA
95650-9415
US

V. Phone/Fax

Practice location:
  • Phone: 916-642-1867
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95041744
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1666702
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: