Provider Demographics
NPI:1265519060
Name:VERTOLLI, SALLY J (FNP)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:J
Last Name:VERTOLLI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:STE 104
Mailing Address - Street 2:572 RIO LINDO AVE
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1851
Mailing Address - Country:US
Mailing Address - Phone:530-899-1627
Mailing Address - Fax:530-899-0366
Practice Address - Street 1:572 RIO LINDO AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1851
Practice Address - Country:US
Practice Address - Phone:530-899-1627
Practice Address - Fax:530-899-0366
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARN285755363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMMM00030MMedicare PIN
CAR20298Medicare UPIN