MEDICARE: SARA PATTAVINA MOULTON, LIMHP, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447537220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARA PATTAVINA MOULTON, LIMHP, P.C.

Provider Business Mailing Address
First Line	:	1804 S 116TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-2902
Country	:	US
Telephone Number	:	402-312-0177
Fax Number	:	402-939-0141

Provider Business Practice Location Address
First Line	:	1804 S 116TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-2902
Country	:	US
Telephone Number	:	402-312-0177
Fax Number	:	402-939-0141

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SARA E PATTAVINA MOULTON
Credential	:
Telephone Number	:	402-312-0177

Provider Enumeration Date	:	11/08/2011
Last Update Date	:	08/11/2021

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