Provider Demographics
NPI:1518414515
Name:NELSON, SARAH (FNP-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 S MAIN ST
Mailing Address - Street 2:STE. 106
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-2534
Mailing Address - Country:US
Mailing Address - Phone:951-371-2703
Mailing Address - Fax:
Practice Address - Street 1:2250 S MAIN ST
Practice Address - Street 2:STE. 106
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2534
Practice Address - Country:US
Practice Address - Phone:951-371-2703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95004893OtherBOARD OF REGISTERED NURSING