=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598046716
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SARAH DANNENBERGER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2011
-----------------------------------------------------
Last Update Date | 09/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4175 N US HIGHWAY 23
-----------------------------------------------------
City | FOSTORIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-536-3640
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4175 N US HIGHWAY 23
-----------------------------------------------------
City | FOSTORIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44830-1998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-536-3640
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | STATE TESTED NURSING ASSISTANT
-----------------------------------------------------
Name | MS. SARAH LYNN DANNENBERGER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 419-536-3640
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | 251J00000X
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------