Provider Demographics
NPI:1144545823
Name:FAN, SAU-MI PRISCILLA (FNP)
Entity type:Individual
Prefix:
First Name:SAU-MI
Middle Name:PRISCILLA
Last Name:FAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6608 MERCY CT STE B
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3171
Mailing Address - Country:US
Mailing Address - Phone:916-241-9844
Mailing Address - Fax:916-241-9844
Practice Address - Street 1:6608 MERCY CT STE B
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3171
Practice Address - Country:US
Practice Address - Phone:916-241-9844
Practice Address - Fax:916-241-9844
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP109278363LF0000X
CAAP109278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily