Healthcare Provider Details

I. General information

NPI: 1023912607
Provider Name (Legal Business Name): MAUREEN VIRGIL RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 SPRING ST STE 3
PLACERVILLE CA
95667-4546
US

IV. Provider business mailing address

4061 SECLUSION LN
PLACERVILLE CA
95667-9234
US

V. Phone/Fax

Practice location:
  • Phone: 530-621-6217
  • Fax: 530-303-0127
Mailing address:
  • Phone: 916-595-9312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number95066491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: