Provider Demographics
NPI:1679878193
Name:POPE-DAUM, GAEA ELENA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:GAEA
Middle Name:ELENA
Last Name:POPE-DAUM
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26250 GREEN ACRES RD
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:CA
Mailing Address - Zip Code:95713-9485
Mailing Address - Country:US
Mailing Address - Phone:530-802-4920
Mailing Address - Fax:
Practice Address - Street 1:8775 SIERRA COLLEGE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-5985
Practice Address - Country:US
Practice Address - Phone:844-867-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024689363LP0808X
CA789932163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95024689OtherBOARD OF REGISTERED NURSING