Provider Demographics
NPI:1114043973
Name:MANN, SALLY HEARN (RN)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:HEARN
Last Name:MANN
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:PO BOX 1640
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96093-1640
Mailing Address - Country:US
Mailing Address - Phone:530-623-1362
Mailing Address - Fax:530-623-1447
Practice Address - Street 1:1450 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:CA
Practice Address - Zip Code:96093-1640
Practice Address - Country:US
Practice Address - Phone:530-623-1362
Practice Address - Fax:530-623-1447
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201228163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse