Healthcare Provider Details

I. General information

NPI: 1871770404
Provider Name (Legal Business Name): SARAH R GHEEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6604 NEWELL HILL RD
LA FAYETTE NY
13084-9420
US

IV. Provider business mailing address

6604 NEWELL HILL ROAD
LAFAYETTE NY
13084-9420
US

V. Phone/Fax

Practice location:
  • Phone: 937-207-9648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number583368-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: