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NPI Code Detail

MEDICARE: ELIZABETH CAROLYN RADSLIFF PNP

MEDICARE: ELIZABETH CAROLYN RADSLIFF PNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse Practitioner358283CA

General Provider Information

NPI Number : 1689659468
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH CAROLYN RADSLIFF PNP
Provider Business Mailing Address
First Line : 8170 LAGUNA BLVD
Second Line : SUITE 210
City : ELK GROVE
State : CA
Zip : 95758-7901
Country : US
Telephone Number : 916-691-5999
Fax Number :
Provider Business Practice Location Address
First Line : 10470 OLD PLACERVILLE RD
Second Line : SUITE 100
City : SACRAMENTO
State : CA
Zip : 95827-2539
Country : US
Telephone Number : 800-470-0071
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2005
Last Update Date : 01/26/2016

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