Healthcare Provider Details

I. General information

NPI: 1609945161
Provider Name (Legal Business Name): NICHOLAS B KAMMERER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 NAPA VALLEJO HWY
NAPA CA
94558-6234
US

IV. Provider business mailing address

2100 NAPA VALLEJO HWY
NAPA CA
94558-6234
US

V. Phone/Fax

Practice location:
  • Phone: 707-253-5000
  • Fax: 707-253-5097
Mailing address:
  • Phone: 707-253-5000
  • Fax: 707-253-5097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA100638
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: