Provider Demographics
NPI:1316935695
Name:NEUBERT, KATALIN J (FNP)
Entity type:Individual
Prefix:
First Name:KATALIN
Middle Name:J
Last Name:NEUBERT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9326 DESCHUTES RD
Mailing Address - Street 2:
Mailing Address - City:PALO CEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:96073-9763
Mailing Address - Country:US
Mailing Address - Phone:530-547-1132
Mailing Address - Fax:530-547-5532
Practice Address - Street 1:9326 DESCHUTES RD
Practice Address - Street 2:
Practice Address - City:PALO CEDRO
Practice Address - State:CA
Practice Address - Zip Code:96073-9763
Practice Address - Country:US
Practice Address - Phone:530-547-1132
Practice Address - Fax:530-547-5532
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295508207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN2955080Medicaid
CARN2955080Medicaid
P02927Medicare UPIN