Healthcare Provider Details

I. General information

NPI: 1992206460
Provider Name (Legal Business Name): ETHEL SAWYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 YORK RD STE 201
BALTIMORE MD
21212-3620
US

IV. Provider business mailing address

170 S GREEN VALLEY PKWY STE 300
HENDERSON NV
89012-3145
US

V. Phone/Fax

Practice location:
  • Phone: 410-800-2169
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number30785
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: