Provider Demographics
NPI:1871102228
Name:NOPWASKEY, SARA LEONA (NP-C)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LEONA
Last Name:NOPWASKEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2673 TREMONTO RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007-3550
Mailing Address - Country:US
Mailing Address - Phone:530-768-4618
Mailing Address - Fax:
Practice Address - Street 1:100 E CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0162
Practice Address - Country:US
Practice Address - Phone:530-722-1111
Practice Address - Fax:530-722-9999
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95096074163W00000X
CA95015161363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse