Healthcare Provider Details

I. General information

NPI: 1952853053
Provider Name (Legal Business Name): NICHOLA HESTER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 BRUCEVILLE RD
SACRAMENTO CA
95823-4671
US

IV. Provider business mailing address

1024 APPOLLO WAY
SACRAMENTO CA
95822-1709
US

V. Phone/Fax

Practice location:
  • Phone: 925-595-3088
  • Fax:
Mailing address:
  • Phone: 925-595-3088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: