Healthcare Provider Details

I. General information

NPI: 1073256905
Provider Name (Legal Business Name): SARA MARIE KANARKIEWICZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/19/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CIRCLE AVE
LYNN MA
01905-3050
US

IV. Provider business mailing address

16 QUAIL RD
PEABODY MA
01960-5010
US

V. Phone/Fax

Practice location:
  • Phone: 781-595-2413
  • Fax:
Mailing address:
  • Phone: 978-335-6112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN2325583
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: