Provider Demographics
NPI:1003445016
Name:REESINK, MARIA KATHERINE
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:KATHERINE
Last Name:REESINK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:KATHERINE
Other - Last Name:SHAFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1641 CREEKSIDE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3831
Mailing Address - Country:US
Mailing Address - Phone:661-972-4322
Mailing Address - Fax:
Practice Address - Street 1:1641 CREEKSIDE DR STE 201
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3831
Practice Address - Country:US
Practice Address - Phone:916-983-3069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA59802363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant