Provider Demographics
NPI:1396304176
Name:NILSSON, KATIE (RN)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:NILSSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 TRANSWORLD DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-3948
Mailing Address - Country:US
Mailing Address - Phone:209-468-4960
Mailing Address - Fax:
Practice Address - Street 1:2707 TRANSWORLD DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-3948
Practice Address - Country:US
Practice Address - Phone:209-479-5924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA552170163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool