Healthcare Provider Details

I. General information

NPI: 1174984942
Provider Name (Legal Business Name): SONOMA HEALTH & SAFETY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 ANDERSON ST
WINNEMUCCA NV
89445-4229
US

IV. Provider business mailing address

653 ANDERSON ST
WINNEMUCCA NV
89445-4229
US

V. Phone/Fax

Practice location:
  • Phone: 775-625-3355
  • Fax: 775-625-3357
Mailing address:
  • Phone: 775-625-3355
  • Fax: 775-625-3357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberNV20101664754
License Number StateNV

VIII. Authorized Official

Name: MRS. NICOLA P BAIN
Title or Position: NURSE PRACTITIONER
Credential: APRN
Phone: 775-625-3355