Provider Demographics
NPI:1013627165
Name:DETHLEFS, ANNIKA ELIZABETH (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ANNIKA
Middle Name:ELIZABETH
Last Name:DETHLEFS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ANNIKA
Other - Middle Name:ELIZABETH
Other - Last Name:NEWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:965 WILSON BLVD APT 1331
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7262
Mailing Address - Country:US
Mailing Address - Phone:916-817-0512
Mailing Address - Fax:
Practice Address - Street 1:82 CLARKSVILLE RD STE 120
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8210
Practice Address - Country:US
Practice Address - Phone:916-983-8868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023461363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily