Provider Demographics
NPI:1730567454
Name:SCHAEFFER, ANTONIA (RN, PHN, NP)
Entity type:Individual
Prefix:
First Name:ANTONIA
Middle Name:
Last Name:SCHAEFFER
Suffix:
Gender:F
Credentials:RN, PHN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5192 COUNTRYSIDE CT
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-8710
Mailing Address - Country:US
Mailing Address - Phone:530-621-2206
Mailing Address - Fax:
Practice Address - Street 1:111484 B AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:916-784-6009
Practice Address - Fax:916-784-6464
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA222235163WC0400X
CA1500363LA2200X, 363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health