Healthcare Provider Details

I. General information

NPI: 1144979329
Provider Name (Legal Business Name): KATRINA WHITAKER RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 VETERANS MEMORIAL CIR
YUBA CITY CA
95993-3011
US

IV. Provider business mailing address

728 RICHLAND RD
YUBA CITY CA
95991-6613
US

V. Phone/Fax

Practice location:
  • Phone: 530-822-7215
  • Fax:
Mailing address:
  • Phone: 530-821-3046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95076942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: