Healthcare Provider Details

I. General information

NPI: 1598972317
Provider Name (Legal Business Name): ROBIN SAGEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 S LENORE AVE # B
WILLITS CA
95490-3632
US

IV. Provider business mailing address

221 S LENORE AVE B
WILLITS CA
95490-3632
US

V. Phone/Fax

Practice location:
  • Phone: 707-456-3853
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN268126
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: