Healthcare Provider Details

I. General information

NPI: 1881941292
Provider Name (Legal Business Name): STEPHANIE ANN SAUVAGEOT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MAIN ST #103
WHEELING WV
26003-2737
US

IV. Provider business mailing address

58681 JOSEPH ST
RAYLAND OH
43943-7811
US

V. Phone/Fax

Practice location:
  • Phone: 304-905-8160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number76453
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: