MEDICARE: RESMI RAVEENDRAN NAIR MSN, FNP-C, PMHNP-BC

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
1	363LF0000X	Family Nurse Practitioner	95022449	CA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95022449	CA

General Provider Information

NPI Number	:	1699538462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RESMI RAVEENDRAN NAIR MSN, FNP-C, PMHNP-BC

Provider Business Mailing Address
First Line	:	7301 GLADWIN WAY
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95757-4002
Country	:	US
Telephone Number	:	408-601-7678
Fax Number	:

Provider Business Practice Location Address
First Line	:	7301 GLADWIN WAY
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95757-4002
Country	:	US
Telephone Number	:	408-601-7678
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	02/05/2024

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