1275519852 NPI number — MRS. SARAH JILL WAGNER HS

Table of content: MRS. SARAH JILL WAGNER HS (NPI 1275519852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275519852 NPI number — MRS. SARAH JILL WAGNER HS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAGNER
Provider First Name:
SARAH
Provider Middle Name:
JILL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
HS
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:
1275519852
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
USCG HQ, COMDT (CG-1122)
Provider Second Line Business Mailing Address:
2100 2ND STREET, RM 5314
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20593-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5201 LEE RD
Provider Second Line Business Practice Location Address:
USCG KAEHLER MEMORIAL MEDICAL CLINIC
Provider Business Practice Location Address City Name:
BUZZARDS BAY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02542-1313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-968-6572
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2005

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: 146D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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