Healthcare Provider Details

I. General information

NPI: 1407587223
Provider Name (Legal Business Name): CARISSA GIORDANI CAHILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12399 RAINBOW DR
TRUCKEE CA
96161-2736
US

IV. Provider business mailing address

12399 RAINBOW DR
TRUCKEE CA
96161-2736
US

V. Phone/Fax

Practice location:
  • Phone: 805-708-8842
  • Fax:
Mailing address:
  • Phone: 805-708-8842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: