Healthcare Provider Details

I. General information

NPI: 1831725696
Provider Name (Legal Business Name): SARAH MICHELLE RUBIN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10215 FERNWOOD RD STE 630
BETHESDA MD
20817-1184
US

IV. Provider business mailing address

1125 FAIRVIEW CT
SILVER SPRING MD
20910-4148
US

V. Phone/Fax

Practice location:
  • Phone: 240-449-3094
  • Fax: 240-489-4415
Mailing address:
  • Phone: 704-614-0264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR220976
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: