Healthcare Provider Details

I. General information

NPI: 1962139246
Provider Name (Legal Business Name): RENEE CELESTE JOHNSON-SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CAPITOL AVE
SACRAMENTO CA
95816-5721
US

IV. Provider business mailing address

2100 CAPITOL AVE
SACRAMENTO CA
95816-5721
US

V. Phone/Fax

Practice location:
  • Phone: 916-442-4985
  • Fax:
Mailing address:
  • Phone: 916-442-4985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number726669
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95422941
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: