Healthcare Provider Details

I. General information

NPI: 1285365841
Provider Name (Legal Business Name): SARAH ELIZABETH WICKMAN EZELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33456 ALVARADO NILES RD
UNION CITY CA
94587-3110
US

IV. Provider business mailing address

33456 ALVARADO NILES RD
UNION CITY CA
94587-3110
US

V. Phone/Fax

Practice location:
  • Phone: 510-675-0600
  • Fax:
Mailing address:
  • Phone: 510-675-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95038207
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95431552
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: