Provider Demographics
NPI:1437554805
Name:DEBOLT, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:DEBOLT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 E ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1856
Mailing Address - Country:US
Mailing Address - Phone:707-476-2177
Mailing Address - Fax:707-476-2142
Practice Address - Street 1:808 E ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1856
Practice Address - Country:US
Practice Address - Phone:707-476-2177
Practice Address - Fax:707-476-2142
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA821246163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management