1407054307 NPI number — MRS. SARA ELIZABETH KLINTWORTH CNP

Table of content: MRS. SARA ELIZABETH KLINTWORTH CNP (NPI 1407054307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407054307 NPI number — MRS. SARA ELIZABETH KLINTWORTH CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLINTWORTH
Provider First Name:
SARA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CNP
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:
1407054307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
10/17/2018
NPI Reactivation Date:
10/31/2018

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7326 MEADOW VIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44273-9709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-806-6062
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3562 RIDGE PARK DR STE D1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRLAWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44333-9294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-664-1670
Provider Business Practice Location Address Fax Number:
330-664-1675
Provider Enumeration Date:
07/03/2007

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:  APRN.CNP.023805 , 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)





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