Healthcare Provider Details

I. General information

NPI: 1083187165
Provider Name (Legal Business Name): SARAH RUTH WAGNER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. SARAH RUTH WOODWARD

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 C ST
SACRAMENTO CA
95816-3300
US

IV. Provider business mailing address

3801 MIRANDA AVE
PALO ALTO CA
94304-1290
US

V. Phone/Fax

Practice location:
  • Phone: 916-733-3390
  • Fax:
Mailing address:
  • Phone: 650-493-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95010666
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95010666
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95010666
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number95010666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: