Provider Demographics
NPI:1972831519
Name:CATES, JERI RENE'E (RN, MSN, FNPC)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:RENE'E
Last Name:CATES
Suffix:
Gender:F
Credentials:RN, MSN, FNPC
Other - Prefix:
Other - First Name:JERI
Other - Middle Name:RENE'E
Other - Last Name:LAWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN, FNPC
Mailing Address - Street 1:5145 SHASTA DAM BLVD
Mailing Address - Street 2:
Mailing Address - City:SHASTA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:96019-9403
Mailing Address - Country:US
Mailing Address - Phone:530-275-5421
Mailing Address - Fax:530-275-1549
Practice Address - Street 1:5145 SHASTA DAM BLVD
Practice Address - Street 2:
Practice Address - City:SHASTA LAKE
Practice Address - State:CA
Practice Address - Zip Code:96019-9403
Practice Address - Country:US
Practice Address - Phone:530-275-5421
Practice Address - Fax:530-275-1549
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19231363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP 19231OtherNP LISCENSE