Healthcare Provider Details

I. General information

NPI: 1063633915
Provider Name (Legal Business Name): SARAH MAGDALEN WHITE MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MAPLE ST
WILBRAHAM MA
01095-1730
US

IV. Provider business mailing address

70 WARE ST
PALMER MA
01069-1515
US

V. Phone/Fax

Practice location:
  • Phone: 413-596-2411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number16754
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: