Provider Demographics
NPI:1043295736
Name:IDEN, SULTANNA B (RN)
Entity Type:Individual
Prefix:MS
First Name:SULTANNA
Middle Name:B
Last Name:IDEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 STOCKTON BLVD
Mailing Address - Street 2:PEDIATRIC ENDOCRINOLOGY
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2208
Mailing Address - Country:US
Mailing Address - Phone:916-734-0494
Mailing Address - Fax:916-734-7070
Practice Address - Street 1:2521 STOCKTON BLVD
Practice Address - Street 2:PEDIATRICS
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2207
Practice Address - Country:US
Practice Address - Phone:916-734-0494
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 463427163WC0400X, 163WD0400X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC0400XNursing Service ProvidersRegistered NurseCase Management
Not Answered163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Not Answered163WP0200XNursing Service ProvidersRegistered NursePediatrics