Provider Demographics
NPI:1558872291
Name:VAILLANCOURT, SARAH (WHNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:VAILLANCOURT
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 ANTIQUE ROSE WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-9594
Mailing Address - Country:US
Mailing Address - Phone:603-913-4238
Mailing Address - Fax:
Practice Address - Street 1:200 COTTAGE AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-4935
Practice Address - Country:US
Practice Address - Phone:209-624-5800
Practice Address - Fax:209-762-6808
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201708786RN163W00000X
OR390200000X
CA95010894363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program