Healthcare Provider Details

I. General information

NPI: 1982086567
Provider Name (Legal Business Name): KRISTINE AHLBERG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 06/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 X ST
SACRAMENTO CA
95817-2229
US

IV. Provider business mailing address

4501 X ST
SACRAMENTO CA
95817-2229
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5845
  • Fax: 916-734-0980
Mailing address:
  • Phone: 916-734-5845
  • Fax: 916-734-0980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN463158
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: