Provider Demographics
NPI:1548021504
Name:HOLLISTER, SARAH ROSEANNE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ROSEANNE
Last Name:HOLLISTER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2787
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95473-2787
Mailing Address - Country:US
Mailing Address - Phone:707-490-8654
Mailing Address - Fax:
Practice Address - Street 1:6695 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-9722
Practice Address - Country:US
Practice Address - Phone:707-490-8654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA743006163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant