Healthcare Provider Details

I. General information

NPI: 1932579943
Provider Name (Legal Business Name): SARA MARIE SKINNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 10/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4941 OLIVEHURST AVE
OLIVEHURST CA
95961-4225
US

IV. Provider business mailing address

4941 OLIVEHURST AVE
OLIVEHURST CA
95961-4225
US

V. Phone/Fax

Practice location:
  • Phone: 530-743-4614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002464
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: