Healthcare Provider Details

I. General information

NPI: 1821337569
Provider Name (Legal Business Name): ERIN BRIDGET CONBOY HEISER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN BRIDGET CONBOY RN

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 STOCKTON BLVD SUITE 3100
SACRAMENTO CA
95817-2207
US

IV. Provider business mailing address

2516 STOCKTON BLVD
SACRAMENTO CA
95817-2208
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7098
  • Fax: 916-734-7070
Mailing address:
  • Phone: 916-734-0494
  • Fax: 916-734-7070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number718371
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number718371
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number718371
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: