Healthcare Provider Details

I. General information

NPI: 1548851884
Provider Name (Legal Business Name): SARAH ROQUEMORE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 01/29/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 CUMBERLAND AVE APT 2
PORTLAND ME
04101-6015
US

IV. Provider business mailing address

152 CUMBERLAND AVE APT 2
PORTLAND ME
04101-6015
US

V. Phone/Fax

Practice location:
  • Phone: 774-454-7473
  • Fax:
Mailing address:
  • Phone: 774-454-7473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN75307
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: