1710402243 NPI number — SARA R SAXTON FNP-BC

Table of content: SARA R SAXTON FNP-BC (NPI 1710402243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710402243 NPI number — SARA R SAXTON FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAXTON
Provider First Name:
SARA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
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:
1710402243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
739 IRVING AVE STE 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13210-1663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-470-7409
Provider Business Mailing Address Fax Number:
315-475-2357

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
739 IRVING AVE STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-470-7409
Provider Business Practice Location Address Fax Number:
315-475-2357
Provider Enumeration Date:
08/05/2017

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: 363L00000X , with the licence number:  F343685-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 0024175083 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0017144117 . This is a "COMMONWEALTH OF VIRGINIA BOARD OF NURSING" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0024175083 . This is a "VIRGINIA BOARD OF NURSING" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".