Healthcare Provider Details

I. General information

NPI: 1548350093
Provider Name (Legal Business Name): SARAH. TERANISHI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHIELD AVE
DAVIS CA
95616-5270
US

IV. Provider business mailing address

1480 INGRID DRIVE
DIXON CA
95620-4222
US

V. Phone/Fax

Practice location:
  • Phone: 530-752-2300
  • Fax:
Mailing address:
  • Phone: 707-678-0604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberT171680
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: