MEDICARE: KATHARINE ADELE SEVERSON FNP

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	FNP 8714	CA

General Provider Information

NPI Number	:	1902801616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHARINE ADELE SEVERSON FNP

Provider Business Mailing Address
First Line	:	7014 STOPE CT
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-8333
Country	:	US
Telephone Number	:	530-642-1787
Fax Number	:

Provider Business Practice Location Address
First Line	:	899 SPRING ST
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-4437
Country	:	US
Telephone Number	:	530-621-3600
Fax Number	:	530-621-3668

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	07/08/2007

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