Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 20435 | CA |
NPI | 1033306287 |
---|---|
Provider Name | Ms. Sherie Ann Viencek |
First Address | Fair Oaks, CA 95628-3541 |
Second Address | Fair Oaks, CA 95628-3541 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2007 |
Last Update Date | 20/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20435 | CHIROPRACTIC LICENSE (01) | CA |