Healthcare Provider Details

I. General information

NPI: 1568226173
Provider Name (Legal Business Name): SARA LEE GOINS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 LODER ST
HORNELL NY
14843-1950
US

IV. Provider business mailing address

228 MAIN ST
DANSVILLE NY
14437-1112
US

V. Phone/Fax

Practice location:
  • Phone: 607-324-5404
  • Fax:
Mailing address:
  • Phone: 585-760-4563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF353533-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: