Healthcare Provider Details

I. General information

NPI: 1740420579
Provider Name (Legal Business Name): KATHERINE HARPER ENSIGN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7273 14TH AVE SUITE 140
SACRAMENTO CA
95820-3566
US

IV. Provider business mailing address

7273 14TH AVE SUITE 140
SACRAMENTO CA
95820-3566
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-6909
  • Fax:
Mailing address:
  • Phone: 916-734-6909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA12298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: