1912989955 NPI number — MRS. SARAH ANNESLEY MULLANE APRN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912989955 NPI number — MRS. SARAH ANNESLEY MULLANE APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULLANE
Provider First Name:
SARAH
Provider Middle Name:
ANNESLEY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GLEASON
Provider Other First Name:
SARAH
Provider Other Middle Name:
ANNESLEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912989955
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 COMMERCE PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-882-2066
Provider Business Mailing Address Fax Number:
203-882-2074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 COMMERCE PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06460-3565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-882-2066
Provider Business Practice Location Address Fax Number:
203-882-2074
Provider Enumeration Date:
11/16/2005

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: 363LF0000X , with the licence number:  001515 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com