1699982736 NPI number — SARAH NABORS FNP

Table of content: SARAH NABORS FNP (NPI 1699982736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699982736 NPI number — SARAH NABORS FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NABORS
Provider First Name:
SARAH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1699982736
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 E 86TH AVE
Provider Second Line Business Mailing Address:
PO BOX 10645
Provider Business Mailing Address City Name:
MERRILLVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46410-6382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-769-1670
Provider Business Mailing Address Fax Number:
219-738-6714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5857 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERRILLVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46410-2666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-884-4450
Provider Business Practice Location Address Fax Number:
219-884-4418
Provider Enumeration Date:
05/17/2007

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: 163W00000X , with the licence number:  28154511A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 28154511A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 28154511A . This is a "NURSING LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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