Individual provider Active NPI

Stephanie Hetrea, NP

  • Acute Care Nurse Practitioner
  • Sacramento, CA
National Provider Identifier
1699164277
Registry record updated Feb 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
95012070 Issued in CA
Practice address
4860 Y St Ste 3740
Sacramento, CA 95817-2307
Phone
(916) 734-4300
NPI assigned
Jan 20, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 041380159 IL
Acute Care Nurse Practitioner 363LA2100X 95012070 CA Primary

Addresses

Primary practice location

4860 Y St Ste 3740
Sacramento, CA 95817-2307

Mailing address

3301 C St Ste 1500
Sacramento, CA 95816-3371
Phone (847) 630-4779

Other practice location 1

2315 Stockton Blvd
Sacramento, CA 95817-2201
Phone (916) 734-2011

Other practice location 2

3301 C St Ste 1500
Sacramento, CA 95816-3371
Phone (916) 734-7463

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200226002515 CA Practitioner - Nurse Practitioner 0042512089 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
041380159ILMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
San Joaquin Faculty Medical Group CurrentSince May 8, 2025 Accepting new patients
County of San Joaquin CurrentSince May 1, 2025 Accepting new patients
County of San Joaquin CurrentSince May 1, 2025 Accepting new patients
Rush University Medical Center Past Accepting new patients

Locations

500 W Hospital Rd
French Camp, CA 95231
Phone (209) 468-6000

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582156800000",
    "number": "1699164277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 C ST STE 1500",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958163371",
            "telephone_number": "847-630-4779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4860 Y ST STE 3740",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172307",
            "telephone_number": "916-734-4300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2315 Stockton Blvd",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958172201",
            "country_code": "US",
            "telephone_number": "916-734-2011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3301 C St Ste 1500",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958163371",
            "country_code": "US",
            "telephone_number": "916-734-7463",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HETREA",
        "first_name": "STEPHANIE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-20",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "IL",
            "license": "041380159",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "95012070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.