Healthcare Provider Details

I. General information

NPI: 1871204362
Provider Name (Legal Business Name): SARAH HUSTED FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4341 GOLDEN CENTER DR STE A
PLACERVILLE CA
95667-6260
US

IV. Provider business mailing address

5417 SAGITARIUS WAY
CITRUS HEIGHTS CA
95610-7520
US

V. Phone/Fax

Practice location:
  • Phone: 530-626-1144
  • Fax:
Mailing address:
  • Phone: 916-342-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021785
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: