Provider Demographics
NPI:1861005274
Name:ENKE, SADIE QUINN
Entity Type:Individual
Prefix:
First Name:SADIE
Middle Name:QUINN
Last Name:ENKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SADIE
Other - Middle Name:QUINN
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:690 OXFORD STREET
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911
Mailing Address - Country:US
Mailing Address - Phone:619-869-1905
Mailing Address - Fax:
Practice Address - Street 1:690 OXFORD STREET
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911
Practice Address - Country:US
Practice Address - Phone:619-869-1905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95230369163W00000X
CA4705927163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse