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General NPI Number Information
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NPI Number | 1720522824
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Entity Type | Individual
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Provider Name | PAIGE ELISE KINGMAN
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Gender | Female
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Dates
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Enumeration Date | 12/07/2016
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 160 GATEWAY DR #110
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City | LINCOLN
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State | CA
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Zip | 95648-3317
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Country | US
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Telephone | 916-434-1623
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Fax | 916-434-1625
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Provider Business Mailing Address
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Address Line | 160 GATEWAY DR #110
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City | LINCOLN
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State | CA
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Zip | 95648-3317
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Country | US
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Telephone | 916-434-1623
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Fax | 916-434-1625
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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 | 95005216
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License Number State | CA
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