Provider Demographics
NPI:1467622969
Name:WYCKOFF, SARAH LOUISE
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LOUISE
Last Name:WYCKOFF
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 1:757 W ANISSA CT
Mailing Address - Street 2:
Mailing Address - City:FARMERSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93223-1202
Mailing Address - Country:US
Mailing Address - Phone:559-350-2832
Mailing Address - Fax:
Practice Address - Street 1:757 W ANISSA CT
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:CA
Practice Address - Zip Code:93223-1202
Practice Address - Country:US
Practice Address - Phone:559-350-2832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 216925164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse