Healthcare Provider Details

I. General information

NPI: 1659679595
Provider Name (Legal Business Name): NAI SIO SAECHAO ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 09/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9948 FIRSTONE DR
SACRAMENTO CA
95829-8149
US

IV. Provider business mailing address

9948 FIRSTONE DR
SACRAMENTO CA
95829-8149
US

V. Phone/Fax

Practice location:
  • Phone: 916-715-5314
  • Fax:
Mailing address:
  • Phone: 916-715-5314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number20218
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: