Healthcare Provider Details

I. General information

NPI: 1730148768
Provider Name (Legal Business Name): SARAH E. CROOK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH E. SIEGELIN

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7916 W JEFFERSON BLVD
FORT WAYNE IN
46804-4140
US

IV. Provider business mailing address

6920 POINTE INVERNESS WAY STE 200 MEDPARTNERS, ATTN: BARB COPELAND
FORT WAYNE IN
46804-7934
US

V. Phone/Fax

Practice location:
  • Phone: 260-432-2297
  • Fax: 260-434-6433
Mailing address:
  • Phone: 260-479-3514
  • Fax: 260-479-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71001039A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: