Healthcare Provider Details

I. General information

NPI: 1003438243
Provider Name (Legal Business Name): SARA GOULD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 E CAPITOL ST NE
WASHINGTON DC
20003-1507
US

IV. Provider business mailing address

850 QUINCY ST NW APT 414
WASHINGTON DC
20011-5874
US

V. Phone/Fax

Practice location:
  • Phone: 202-371-9393
  • Fax:
Mailing address:
  • Phone: 845-670-9591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1040633
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: