Healthcare Provider Details

I. General information

NPI: 1861037012
Provider Name (Legal Business Name): SARAH KINGMAN REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 KING ST
NORTHAMPTON MA
01060
US

IV. Provider business mailing address

783 FOWLER RD
WHITINGHAM VT
05361-9626
US

V. Phone/Fax

Practice location:
  • Phone: 413-664-8717
  • Fax: 413-665-9383
Mailing address:
  • Phone: 802-368-2493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN2313889
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: