Healthcare Provider Details

I. General information

NPI: 1942266895
Provider Name (Legal Business Name): LESLIE KATHRYN TROTTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 C ST
SACRAMENTO CA
95814-1023
US

IV. Provider business mailing address

7325 SIDNEY DR
CITRUS HEIGHTS CA
95610-2969
US

V. Phone/Fax

Practice location:
  • Phone: 916-874-5303
  • Fax: 916-442-1878
Mailing address:
  • Phone: 916-721-9301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number411824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: