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General NPI Number Information
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NPI Number | 1801630058
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Entity Type | Individual
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Provider Name | CAVAN QUAM FNP
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Gender | Male
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Dates
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Enumeration Date | 06/22/2024
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Last Update Date | 06/22/2024
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Provider Practice Location Address
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Address Line | 8110 TIMBERLAKE WAY
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City | SACRAMENTO
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State | CA
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Zip | 95823-5401
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Country | US
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Telephone | 916-689-4111
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Fax |
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Provider Business Mailing Address
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Address Line | 73 52ND ST
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City | SACRAMENTO
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State | CA
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Zip | 95819-2307
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Country | US
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Telephone | 530-570-1812
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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 | 95030658
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License Number State | CA
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