Healthcare Provider Details

I. General information

NPI: 1134832892
Provider Name (Legal Business Name): KATIE MARIE MADRIL RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 CAPITOL AVE
SACRAMENTO CA
95816-6039
US

IV. Provider business mailing address

2000 DENTON CT
ROCKLIN CA
95765-5339
US

V. Phone/Fax

Practice location:
  • Phone: 916-887-0508
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number4814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: