Healthcare Provider Details

I. General information

NPI: 1093836090
Provider Name (Legal Business Name): MARIE-NICOLE LAPEYRADE P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 DUCKHORN DR STE 200
SACRAMENTO CA
95834-2590
US

IV. Provider business mailing address

PO BOX 832
PLACERVILLE CA
95667-0832
US

V. Phone/Fax

Practice location:
  • Phone: 916-419-9900
  • Fax: 916-419-9699
Mailing address:
  • Phone: 209-461-3196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA148960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: