Healthcare Provider Details

I. General information

NPI: 1104489392
Provider Name (Legal Business Name): SARAH EVELYN BURKHARDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD
NEWARK DE
19718-2200
US

IV. Provider business mailing address

15 HATTERAS CT
ELKTON MD
21921-6294
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1000
  • Fax:
Mailing address:
  • Phone: 443-945-1612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL6-0A00806
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: