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General NPI Number Information
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NPI Number | 1326513441
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Entity Type | Individual
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Provider Name | SANDRA LYNN NIBBELINK AHEARN NP
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Gender | Female
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Dates
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Enumeration Date | 10/04/2018
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 3300 VISTA WAY STE B
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City | OCEANSIDE
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State | CA
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Zip | 92056-3633
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Country | US
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Telephone | 760-967-9900
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Fax | 760-967-6769
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Provider Business Mailing Address
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Address Line | 4225 EXECUTIVE SQ STE 450
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City | LA JOLLA
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State | CA
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Zip | 92037-8411
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Country | US
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Telephone | 858-810-8000
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Fax | 858-268-1911
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP95007904
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License Number State | CA
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