Provider Demographics
NPI:1356552491
Name:KANSIER, STEPHEN LEE
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LEE
Last Name:KANSIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:LEE
Other - Last Name:KANSIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN,FNP
Mailing Address - Street 1:6017 SOUTHERNESS DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7690
Mailing Address - Country:US
Mailing Address - Phone:916-985-2561
Mailing Address - Fax:916-351-3001
Practice Address - Street 1:300 PRISON RD
Practice Address - Street 2:
Practice Address - City:REPRESA
Practice Address - State:CA
Practice Address - Zip Code:95671-3001
Practice Address - Country:US
Practice Address - Phone:916-985-2561
Practice Address - Fax:916-351-3001
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA222242363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily