Healthcare Provider Details

I. General information

NPI: 1558735340
Provider Name (Legal Business Name): SANDRA ROWELL-CONNORS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 POSADA LN STE A
TEMPLETON CA
93465-4055
US

IV. Provider business mailing address

1941 JOHNSON AVE STE 101
SAN LUIS OBISPO CA
93401-4154
US

V. Phone/Fax

Practice location:
  • Phone: 805-782-8844
  • Fax: 833-613-2635
Mailing address:
  • Phone: 805-782-8844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95003857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: