Provider Demographics
NPI:1487089090
Name:SEVERSON, MARY ELIZABETH (WHNP-BC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:SEVERSON
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 F ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3226
Mailing Address - Country:US
Mailing Address - Phone:916-733-7111
Mailing Address - Fax:916-733-7110
Practice Address - Street 1:5301 F ST
Practice Address - Street 2:SUITE 207
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3226
Practice Address - Country:US
Practice Address - Phone:916-733-7111
Practice Address - Fax:916-733-7110
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22521363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health