Basic Information
| Provider Information | |||||||||
| NPI: | 1003466616 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NOBLETT | ||||||||
| FirstName: | SANDY | ||||||||
| MiddleName: | YI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5809 20TH AVE | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958203107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9165255522 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4001 J ST | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958193600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164534545 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2019 | ||||||||
| LastUpdateDate: | 03/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 95025619 | CA | N | Nursing Service Providers | Registered Nurse | 367500000X | 95001260 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.