Individual
ELAINE RENE ICENHOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5220 ROBERT J MATHEWS PKWY, EL DORADO HILLS, CA 95762-5705
(916) 939-4960
Mailing address
5220 ROBERT J MATHEWS PKWY, EL DORADO HILLS, CA 95762-5705
(916) 939-4960
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
9800
CA
Other
Enumeration date
08/13/2021
Last updated
08/13/2021
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