Healthcare Provider Details

I. General information

NPI: 1275823585
Provider Name (Legal Business Name): SARAH GRACE LUDWICK RN PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 VETERANS MEMORIAL CIR
YUBA CITY CA
95993-3011
US

IV. Provider business mailing address

1445 VETERAN'S MEMORIAL CIRCLE
YUBA CITY CA
95993
US

V. Phone/Fax

Practice location:
  • Phone: 530-822-7215
  • Fax:
Mailing address:
  • Phone: 530-822-7215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN706613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: