Mae Ruth Doctor, NP
Individual provider Active NPI Family Nurse Practitioner · McClellan, CA
NPI 1104196930 · NPPES record last updated Jan 11, 2012
Key facts
- NPI
- 1104196930
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 19705 (CA)
- Practice address
- 5342 Dudley Blvd
McClellan, CA 95652-1012 - Phone
- (916) 561-7400
- NPI assigned
- Jan 11, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19705 | CA | MD | Massage Therapist |
| APN001042 | NV | MD | Family Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 19705 | CA | Yes |
| Family Nurse Practitioner | 363LF0000X | APN001042 | NV |
Addresses
Primary practice location
5342 Dudley Blvd
McClellan, CA 95652-1012
Mailing address
5342 Dudley Blvd
McClellan, CA 95652-1012
Other providers in McClellan, CA
- Jody Lynn Decker
- Cesia E Del Cid
- Anna Depello
- Rino Dizon
- Federico Samortin Doctor Jr.
- Kim Duke
- Jasmine Elliott
- Emilce Integrative Care, a Psychological Corporation
- Kyra Ivanna Evans-Greagor
- Samantha Ewing
All providers in McClellan, CA · Family Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.