1134595242 NPI number — MRS. SARAH O DIRK NP-C

Table of content: MRS. SARAH O DIRK NP-C (NPI 1134595242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134595242 NPI number — MRS. SARAH O DIRK NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIRK
Provider First Name:
SARAH
Provider Middle Name:
O
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP-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:
1134595242
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11100 EUCLID AVE
Provider Second Line Business Mailing Address:
SEIDMAN 3
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44106-1716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-286-3340
Provider Business Mailing Address Fax Number:
216-286-5776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11100 EUCLID AVE
Provider Second Line Business Practice Location Address:
SEIDMAN 3
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44106-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-286-3340
Provider Business Practice Location Address Fax Number:
216-286-5776
Provider Enumeration Date:
08/12/2015

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: 363LG0600X , with the licence number:  COA.17950-NP , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: COA.17950-NP . This is a "OHIO BOARD OF NURSING" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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