Healthcare Provider Details

I. General information

NPI: 1639620057
Provider Name (Legal Business Name): SARAH ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH MARTIN

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 HIGH ST SUITE 2-F
PORTSMOUTH VA
23707-3213
US

IV. Provider business mailing address

3640 HIGH ST SUITE 2-F
PORTSMOUTH VA
23707-3213
US

V. Phone/Fax

Practice location:
  • Phone: 757-483-3030
  • Fax: 757-484-7239
Mailing address:
  • Phone: 757-483-3030
  • Fax: 757-484-7239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024174140
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: