Healthcare Provider Details

I. General information

NPI: 1346488210
Provider Name (Legal Business Name): ANNETTE L NEEDHAM NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2009
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD HOUSESTAFF
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

2315 STOCKTON BLVD HOUSESTAFF BUILDING
SACRAMENTO CA
95817-2201
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7211
  • Fax: 916-734-0432
Mailing address:
  • Phone: 916-734-7211
  • Fax: 916-734-0432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9180953
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22589
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: