Basic Information
| Provider Information | |||||||||
| NPI: | 1710396825 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CANAVESIO | ||||||||
| FirstName: | LINDSEY | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | ACNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 ETHAN WAY STE 600 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958252296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166793590 | ||||||||
| FaxNumber: | 9164823647 | ||||||||
| Practice Location | |||||||||
| Address1: | 1485 RIVER PARK DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958154530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166793590 | ||||||||
| FaxNumber: | 9164823647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2014 | ||||||||
| LastUpdateDate: | 10/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 95001010 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.