Healthcare Provider Details

I. General information

NPI: 1386653301
Provider Name (Legal Business Name): JACQUELINE SYLVIA MCBRIDE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

651 I ST
SACRAMENTO CA
95814-2400
US

IV. Provider business mailing address

116 GROVE ST
ROSEVILLE CA
95678-1518
US

V. Phone/Fax

Practice location:
  • Phone: 916-874-7360
  • Fax:
Mailing address:
  • Phone: 916-772-6352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number509071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: