Provider Demographics
NPI:1104081421
Name:SAULSBURY, CLELLAN MICHAEL (RN FNP MS)
Entity type:Individual
Prefix:MR
First Name:CLELLAN
Middle Name:MICHAEL
Last Name:SAULSBURY
Suffix:
Gender:M
Credentials:RN FNP MS
Other - Prefix:
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Mailing Address - Street 1:1000 GREENLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370
Mailing Address - Country:US
Mailing Address - Phone:209-536-5000
Mailing Address - Fax:209-536-3877
Practice Address - Street 1:193 FAIRVIEW LANE
Practice Address - Street 2:SUITE L
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370
Practice Address - Country:US
Practice Address - Phone:209-536-3720
Practice Address - Fax:209-536-3877
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA173545363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily