Provider Demographics
NPI:1013496538
Name:KATSARELIS, EMMELINE JOYCE (NP)
Entity Type:Individual
Prefix:MS
First Name:EMMELINE
Middle Name:JOYCE
Last Name:KATSARELIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:EMMELINE
Other - Middle Name:JOYCE
Other - Last Name:SALCEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1910 CUSTOMER CARE WAY
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-5167
Mailing Address - Country:US
Mailing Address - Phone:209-384-6493
Mailing Address - Fax:
Practice Address - Street 1:2240 W MONTE VISTA AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-9667
Practice Address - Country:US
Practice Address - Phone:209-667-1270
Practice Address - Fax:209-667-1269
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009435363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner