Provider Demographics
NPI:1083722813
Name:CHIMARUSTI, SALLY A (APN)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:A
Last Name:CHIMARUSTI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2874 N CARSON ST STE 127
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-1681
Mailing Address - Country:US
Mailing Address - Phone:775-882-1300
Mailing Address - Fax:775-882-1300
Practice Address - Street 1:2874 N CARSON ST STE 127
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-1681
Practice Address - Country:US
Practice Address - Phone:775-882-1300
Practice Address - Fax:775-882-1300
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV37303Medicare ID - Type Unspecified
NVS75103Medicare UPIN