Healthcare Provider Details

I. General information

NPI: 1093151466
Provider Name (Legal Business Name): SARAH ELIZABETH HUTH R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS SARAH ELIZABETH FULK

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6279 E STATE BLVD
FORT WAYNE IN
46815-7641
US

IV. Provider business mailing address

9523 SUGAR MILL DR
FORT WAYNE IN
46835-9608
US

V. Phone/Fax

Practice location:
  • Phone: 260-492-0951
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28164389A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: