Provider Demographics
NPI:1790664027
Name:NILSSON, GEMMA SIAN PAMELA
Entity type:Individual
Prefix:
First Name:GEMMA
Middle Name:SIAN PAMELA
Last Name:NILSSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GEMMA
Other - Middle Name:SIAN PAMELA
Other - Last Name:DAVIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 DAVIES CT
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-7750
Mailing Address - Country:US
Mailing Address - Phone:925-922-7274
Mailing Address - Fax:
Practice Address - Street 1:4001 J ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3626
Practice Address - Country:US
Practice Address - Phone:916-453-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-29
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO155583367500000X
CA95002677367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty