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1689349391
ELAINE RENE ICENHOUR
EL DORADO HILLS, CA
NPI
1689349391
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Former Name
ELAINE RENE SHADY
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363L00000X Nurse Practitioner
(Licence: CA 9800)
Enumeration Date
2021-08-13
Last Update Date
2021-08-13
Business Address
ELAINE RENE ICENHOUR
5220 ROBERT J MATHEWS PKWY
EL DORADO HILLS, CA 95762-5705
Phone number: 916-939-4960
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Mailing Address
ELAINE RENE ICENHOUR
5220 ROBERT J MATHEWS PKWY
EL DORADO HILLS, CA 95762-5705
Phone number: 916-939-4960
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