Healthcare Provider Details

I. General information

NPI: 1851203178
Provider Name (Legal Business Name): NANCY ANN SPERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 BRIDGEWATER CIR
STOCKTON CA
95219-2006
US

IV. Provider business mailing address

4811 BRIDGEWATER CIR
STOCKTON CA
95219-2006
US

V. Phone/Fax

Practice location:
  • Phone: 209-915-5592
  • Fax:
Mailing address:
  • Phone: 209-915-5592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number715645
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: