1750643706 NPI number — SARAH STOLLAR SMITH CRNP

Table of content: SARAH STOLLAR SMITH CRNP (NPI 1750643706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750643706 NPI number — SARAH STOLLAR SMITH CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
SARAH
Provider Middle Name:
STOLLAR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STOLLAR
Provider Other First Name:
SARAH
Provider Other Middle Name:
BROOKE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750643706
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
85 1ST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALTHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02451-1105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-647-7246
Provider Business Mailing Address Fax Number:
781-290-0720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALTHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02451-1105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-647-7246
Provider Business Practice Location Address Fax Number:
781-290-0720
Provider Enumeration Date:
06/14/2012

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: 363LA2200X , with the licence number:  SP012138 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: SP012138 . This is a "ADULT NURSE PRACTITIONER LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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