Provider Demographics
NPI:1356643076
Name:KANNEH-WARITAY, SAPHIE S (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:SAPHIE
Middle Name:S
Last Name:KANNEH-WARITAY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SAPHIE
Other - Middle Name:S
Other - Last Name:BANGURAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:100 STERLING OAKS DR APT 263
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-9462
Mailing Address - Country:US
Mailing Address - Phone:678-571-1423
Mailing Address - Fax:
Practice Address - Street 1:2145 5TH AVE
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-5870
Practice Address - Country:US
Practice Address - Phone:530-534-5394
Practice Address - Fax:530-534-3018
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA514558363LF0000X
GARN147934363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily