=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386484574
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH HARSHAW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2024
-----------------------------------------------------
Last Update Date | 09/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6451 VILLAGE LN
-----------------------------------------------------
City | MACUNGIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18062-8484
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-967-2772
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2100 MACK BLVD FL 4
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18103-5622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-884-4500
-----------------------------------------------------
Fax | 484-884-0699
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 719543
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | SP030361
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------