Provider Demographics
NPI:1417320896
Name:HOLMGREN, SARAH SKINNER (NP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:SKINNER
Last Name:HOLMGREN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 HOLLIS ST
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2016
Mailing Address - Country:US
Mailing Address - Phone:510-806-2100
Mailing Address - Fax:510-806-2548
Practice Address - Street 1:5800 HOLLIS ST
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2016
Practice Address - Country:US
Practice Address - Phone:510-806-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95059926363LA2200X
CA95003442363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health