Healthcare Provider Details

I. General information

NPI: 1356460992
Provider Name (Legal Business Name): KATHERINE ANN STAPLETON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 N COTTONWOOD ST
WOODLAND CA
95695-2585
US

IV. Provider business mailing address

14 N COTTONWOOD ST
WOODLAND CA
95695-2585
US

V. Phone/Fax

Practice location:
  • Phone: 539-666-8630
  • Fax:
Mailing address:
  • Phone: 530-666-8630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number141184
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: