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General NPI Number Information
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NPI Number | 1013627165
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Entity Type | Individual
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Provider Name | ANNIKA ELIZABETH DETHLEFS FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/30/2022
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Last Update Date | 01/15/2024
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Provider Practice Location Address
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Address Line | 82 CLARKSVILLE RD STE 120
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City | FOLSOM
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State | CA
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Zip | 95630-8210
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Country | US
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Telephone | 916-983-8868
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Fax |
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Provider Business Mailing Address
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Address Line | 965 WILSON BLVD APT 1331
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-7262
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Country | US
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Telephone | 916-817-0512
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95023461
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License Number State | CA
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