Healthcare Provider Details

I. General information

NPI: 1356552491
Provider Name (Legal Business Name): STEPHEN LEE KANSIER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: STEPHEN LEE KANSIER R.N.,FNP

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PRISON RD
REPRESA CA
95671-3001
US

IV. Provider business mailing address

6017 SOUTHERNESS DR
EL DORADO HILLS CA
95762-7690
US

V. Phone/Fax

Practice location:
  • Phone: 916-985-2561
  • Fax: 916-351-3001
Mailing address:
  • Phone: 916-985-2561
  • Fax: 916-351-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number222242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: