Provider Demographics
NPI:1699548099
Name:SACDALAN, MARY JANE (RN)
Entity type:Individual
Prefix:
First Name:MARY JANE
Middle Name:
Last Name:SACDALAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 BAILYANN PL
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-7535
Mailing Address - Country:US
Mailing Address - Phone:903-787-3138
Mailing Address - Fax:
Practice Address - Street 1:525 BAILYANN PL
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-7535
Practice Address - Country:US
Practice Address - Phone:903-787-3138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95136097163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse