Provider Demographics
NPI:1922855907
Name:GLASHAN, SARA KATHLEEN (RN)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:KATHLEEN
Last Name:GLASHAN
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:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:PENNGROVE
Mailing Address - State:CA
Mailing Address - Zip Code:94951-0265
Mailing Address - Country:US
Mailing Address - Phone:707-480-1446
Mailing Address - Fax:
Practice Address - Street 1:790 SONOMA AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4713
Practice Address - Country:US
Practice Address - Phone:707-544-3295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA570884163WW0000X, 163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WW0000XNursing Service ProvidersRegistered NurseWound Care