Healthcare Provider Details

I. General information

NPI: 1437084845
Provider Name (Legal Business Name): SIERRA SOLACE PALLIATIVE CARE A NURSING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2219 MEWUK DR
SOUTH LAKE TAHOE CA
96150-5313
US

IV. Provider business mailing address

2219 MEWUK DR
SOUTH LAKE TAHOE CA
96150-5313
US

V. Phone/Fax

Practice location:
  • Phone: 530-416-5684
  • Fax:
Mailing address:
  • Phone: 530-416-5684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAURA MACHELE JENSEN RILEY
Title or Position: OWNER/CEO
Credential: FNP-BC
Phone: 530-416-5684