Provider Demographics
NPI:1902026735
Name:SPARROW, GILLIAN MARY (RN)
Entity Type:Individual
Prefix:
First Name:GILLIAN
Middle Name:MARY
Last Name:SPARROW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:LOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:95551-0451
Mailing Address - Country:US
Mailing Address - Phone:707-733-5012
Mailing Address - Fax:
Practice Address - Street 1:359 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:LOLETA
Practice Address - State:CA
Practice Address - Zip Code:95551-0451
Practice Address - Country:US
Practice Address - Phone:707-733-5012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN219103163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARVN004220OtherIN HOME OPERATIONS