Healthcare Provider Details

I. General information

NPI: 1609810704
Provider Name (Legal Business Name): KAREN DAWN MEDEIROS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 BROADWAY STE 1100
SACRAMENTO CA
95820-1527
US

IV. Provider business mailing address

5135 DORY WAY
FAIR OAKS CA
95628
US

V. Phone/Fax

Practice location:
  • Phone: 916-874-9670
  • Fax: 916-874-9297
Mailing address:
  • Phone: 916-961-0289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number205542
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: