Healthcare Provider Details

I. General information

NPI: 1790414209
Provider Name (Legal Business Name): SARAH ELIZABETH VALENTINE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 EVANSWOOD DR
JACKSON OH
45640-8889
US

IV. Provider business mailing address

75 EVANSWOOD DR
JACKSON OH
45640-8889
US

V. Phone/Fax

Practice location:
  • Phone: 740-777-8750
  • Fax:
Mailing address:
  • Phone: 740-777-8750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberRN.431957
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: