Provider Demographics
NPI:1598474504
Name:TOWNER, SALLY S
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:S
Last Name:TOWNER
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 1:7130 CONCORD PL
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-6314
Mailing Address - Country:US
Mailing Address - Phone:408-483-6399
Mailing Address - Fax:
Practice Address - Street 1:7130 CONCORD PL
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-6314
Practice Address - Country:US
Practice Address - Phone:408-483-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747A0650X
CA3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA666OtherNA
CANAOtherNA