Basic Information
| Provider Information | |||||||||
| NPI: | 1356552491 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KANSIER | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | KANSIER | ||||||||
| OtherFirstName: | STEPHEN | ||||||||
| OtherMiddleName: | LEE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | R.N.,FNP | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6017 SOUTHERNESS DR | ||||||||
| Address2: | |||||||||
| City: | EL DORADO HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957627690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169852561 | ||||||||
| FaxNumber: | 9163513001 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 PRISON RD | ||||||||
| Address2: | |||||||||
| City: | REPRESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956713001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169852561 | ||||||||
| FaxNumber: | 9163513001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 222242 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.