Healthcare Provider Details

I. General information

NPI: 1235403395
Provider Name (Legal Business Name): SARA D KRUMLAUF CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST STE. 4490
DAYTON OH
45409-2722
US

IV. Provider business mailing address

1 WYOMING ST STE. 4490
DAYTON OH
45409-2722
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-5287
  • Fax: 937-208-5292
Mailing address:
  • Phone: 937-208-5287
  • Fax: 937-208-5292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberCOA 13070-NS
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: