Healthcare Provider Details

I. General information

NPI: 1760290795
Provider Name (Legal Business Name): NICOLE SBARRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE HARPENAU

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W 3RD ST
DAYTON OH
45428-9000
US

IV. Provider business mailing address

4100 W 3RD ST
DAYTON OH
45428-9000
US

V. Phone/Fax

Practice location:
  • Phone: 937-268-6511
  • Fax:
Mailing address:
  • Phone: 937-268-6511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number8867343
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number8867343
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: