Healthcare Provider Details

I. General information

NPI: 1376529669
Provider Name (Legal Business Name): KATIE A HAERTLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

6415 FILBERT AVE
ORANGEVALE CA
95662-4109
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2781
  • Fax:
Mailing address:
  • Phone: 916-987-5364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0218X
TaxonomyPediatric Oncology Registered Nurse
License Number365902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: