1619312618 NPI number — MRS. SARA ELIZABETH STENGEL CRNA

Table of content: MRS. SARA ELIZABETH STENGEL CRNA (NPI 1619312618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619312618 NPI number — MRS. SARA ELIZABETH STENGEL CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STENGEL
Provider First Name:
SARA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PAKULSKI
Provider Other First Name:
SARA
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619312618
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
68 S SERVICE RD STE 350
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11747-2358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-945-3000
Provider Business Mailing Address Fax Number:
703-563-6256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16550-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-877-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  092770 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 209010658 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)