Healthcare Provider Details

I. General information

NPI: 1992324818
Provider Name (Legal Business Name): SIERRA M SALLEE DNP, PNP-AC, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SIERRA WOLMAN RN

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

V. Phone/Fax

Practice location:
  • Phone: 323-660-2450
  • Fax:
Mailing address:
  • Phone: 323-660-2450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN60837016
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95022859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: