Healthcare Provider Details

I. General information

NPI: 1740446129
Provider Name (Legal Business Name): SARAH B STOSE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E WASHINGTON ST SUITE 150
MEDINA OH
44256-3335
US

IV. Provider business mailing address

801 E WASHINGTON ST SUITE 150
MEDINA OH
44256-3335
US

V. Phone/Fax

Practice location:
  • Phone: 330-722-1069
  • Fax: 330-764-9712
Mailing address:
  • Phone: 330-722-1069
  • Fax: 330-764-9712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN317294
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: