Healthcare Provider Details

I. General information

NPI: 1821320326
Provider Name (Legal Business Name): SARAH ELLEN GAVIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. SARAH ELLEN MANCOSKY

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA MEDDAC BAVARIA CMR 411, BLDG 700, ROSE BARRACKS
APO AE
09112
US

IV. Provider business mailing address

CMR 459 BOX 24903
APO AE
09139
US

V. Phone/Fax

Practice location:
  • Phone: 0114996628347
  • Fax: 011499662834721
Mailing address:
  • Phone: 00499547871864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 00169575
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: