1952391435 NPI number — MRS. SARAH BLACK WIESENDANGER PATTON PA-C

Table of content: MRS. SARAH BLACK WIESENDANGER PATTON PA-C (NPI 1952391435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952391435 NPI number — MRS. SARAH BLACK WIESENDANGER PATTON PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATTON
Provider First Name:
SARAH
Provider Middle Name:
BLACK WIESENDANGER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952391435
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23 ROSEMARY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREEPORT
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04032-6034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-450-1361
Provider Business Mailing Address Fax Number:
206-346-6022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 CONGRESS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04102-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-661-0100
Provider Business Practice Location Address Fax Number:
207-661-0199
Provider Enumeration Date:
10/25/2005

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: 363AM0700X , with the licence number:  PA10005002 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA2186 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1551PA . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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