Healthcare Provider Details

I. General information

NPI: 1902100142
Provider Name (Legal Business Name): SARA A REMILLARD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA A MOORE CRNA

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ATWELL RD
COOPERSTOWN NY
13326-1301
US

IV. Provider business mailing address

PO BOX 725
COOPERSTOWN NY
13326-0725
US

V. Phone/Fax

Practice location:
  • Phone: 607-547-3153
  • Fax: 607-547-6539
Mailing address:
  • Phone: 607-547-3153
  • Fax: 607-547-6539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number542991
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: