Provider Demographics
NPI:1831533553
Name:TREADWELL, JENNIFER YVONNE (APRN, CPNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:YVONNE
Last Name:TREADWELL
Suffix:
Gender:F
Credentials:APRN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 STOCKTON BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-7098
Mailing Address - Country:US
Mailing Address - Phone:916-887-4877
Mailing Address - Fax:916-887-4835
Practice Address - Street 1:1625 STOCKTON BLVD STE 112
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7098
Practice Address - Country:US
Practice Address - Phone:916-887-4877
Practice Address - Fax:916-887-4835
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06244363LP0200X
CA95015720363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA292348YH54OtherMEDICARE - PTAN
LA2336037Medicaid