Provider Demographics
NPI:1144366865
Name:CLAYTON, THERESA (FNP)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:WINTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1650 RESPONSE RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4807
Mailing Address - Country:US
Mailing Address - Phone:916-614-5149
Mailing Address - Fax:916-614-5115
Practice Address - Street 1:1650 RESPONSE RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4807
Practice Address - Country:US
Practice Address - Phone:916-614-5149
Practice Address - Fax:916-614-5115
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16913363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily