Healthcare Provider Details

I. General information

NPI: 1528528072
Provider Name (Legal Business Name): KATHERINE DIANA BOWERS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE DIANA DITRIH

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 MARSHALL WAY FL 1
PLACERVILLE CA
95667-5722
US

IV. Provider business mailing address

1095 MARSHALL WAY FL 1
PLACERVILLE CA
95667-5722
US

V. Phone/Fax

Practice location:
  • Phone: 530-626-2920
  • Fax:
Mailing address:
  • Phone: 530-626-2920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95011166
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: