=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013612753
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHERINE NYQUIST PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2023
-----------------------------------------------------
Last Update Date | 12/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4201 TOWN CENTER BLVD BLDG D
-----------------------------------------------------
City | EL DORADO HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95762-7100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-344-2070
-----------------------------------------------------
Fax | 530-748-0332
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 45680
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94145-0680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-626-2618
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 62987
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------