Healthcare Provider Details

I. General information

NPI: 1275156135
Provider Name (Legal Business Name): SARAH RUTH BROWN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAIRO- DURHAM CENTRAL SCHOOL DISTRICT 1301 ROUTE 145
CAIRO NY
12413
US

IV. Provider business mailing address

PO BOX 598
CAIRO NY
12413-0598
US

V. Phone/Fax

Practice location:
  • Phone: 518-622-0490
  • Fax: 518-622-0493
Mailing address:
  • Phone: 518-622-0490
  • Fax: 518-622-0493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number719057
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: