Provider Demographics
NPI:1194137307
Name:SEBOLD, COLLEEN (LVN)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:
Last Name:SEBOLD
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5663 OVERLEAF WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1930
Mailing Address - Country:US
Mailing Address - Phone:916-928-4207
Mailing Address - Fax:
Practice Address - Street 1:5663 OVERLEAF WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-1930
Practice Address - Country:US
Practice Address - Phone:916-928-4207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN119659164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse