Healthcare Provider Details

I. General information

NPI: 1174605661
Provider Name (Legal Business Name): SARA ELIZABETH WANNER ACNP-BC, RN.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW STE 5A8 MEDSTAR WASHINGTON HOSPITAL CENTER
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

110 IRVING ST NW STE 5A8 MEDSTAR WASHINGTON HOSPITAL CENTER
WASHINGTON DC
20010-3017
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-9266
  • Fax: 202-877-3455
Mailing address:
  • Phone: 202-877-9266
  • Fax: 202-877-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN1016890
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1016890
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: