MEDICARE: SARAH NELSEN RDH

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	124Q00000X	Dental Hygienist	0402207193	VA

General Provider Information

NPI Number	:	1659026409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH NELSEN RDH

Provider Business Mailing Address
First Line	:	4281 BEAR BUG LN
Second Line	:
City	:	BEALETON
State	:	VA
Zip	:	22712-7366
Country	:	US
Telephone Number	:	703-659-3304
Fax Number	:

Provider Business Practice Location Address
First Line	:	392 GARRISONVILLE RD STE 205
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-1576
Country	:	US
Telephone Number	:	540-659-6816
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2022
Last Update Date	:	02/18/2022

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