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General NPI Number Information
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NPI Number | 1679878193
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Entity Type | Individual
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Provider Name | GAEA ELENA POPE-DAUM PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/13/2011
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 508 GIBSON DR STE 150-160
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City | ROSEVILLE
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State | CA
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Zip | 95678-5794
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Country | US
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Telephone | 916-865-3670
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 808
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City | COLFAX
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State | CA
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Zip | 95713-0808
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Country | US
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Telephone | 530-802-4920
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | NP95024689
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 789932
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License Number State | CA
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