Healthcare Provider Details

I. General information

NPI: 1699173302
Provider Name (Legal Business Name): SARAH E RABE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 WEAVER RD
FLORENCE KY
41042-2998
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-655-2755
  • Fax: 859-655-2755
Mailing address:
  • Phone: 859-655-2755
  • Fax: 859-655-2755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2165
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2212
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: