Provider Demographics
NPI:1437161643
Name:MANN, SARAH (NP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MANN
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 1:1235 W VINE ST # 20
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-5109
Mailing Address - Country:US
Mailing Address - Phone:209-339-7600
Mailing Address - Fax:
Practice Address - Street 1:1235 W VINE ST # 20
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-5109
Practice Address - Country:US
Practice Address - Phone:209-339-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN533058363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner