Provider Demographics
NPI:1689099244
Name:AFABLEMARSH, ROWENA (BRN)
Entity Type:Individual
Prefix:
First Name:ROWENA
Middle Name:
Last Name:AFABLEMARSH
Suffix:
Gender:F
Credentials:BRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4721 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-3329
Mailing Address - Country:US
Mailing Address - Phone:916-580-5683
Mailing Address - Fax:
Practice Address - Street 1:4721 65TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-3329
Practice Address - Country:US
Practice Address - Phone:916-580-5683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA777937163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$OtherSSN