Healthcare Provider Details

I. General information

NPI: 1275679979
Provider Name (Legal Business Name): SANDRA GAIL YOCUM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 MONTAGUE LN
LINCOLN CA
95648-3252
US

IV. Provider business mailing address

5074 NEWTOWN RD
PLACERVILLE CA
95667-8373
US

V. Phone/Fax

Practice location:
  • Phone: 916-543-9863
  • Fax:
Mailing address:
  • Phone: 530-644-4157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number293018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: