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General NPI Number Information
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NPI Number | 1740520717
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Entity Type | Individual
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Provider Name | SARAH SUZANNE BORTONE FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/27/2013
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 620 W EDISON RD SUITE 118
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City | MISHAWAKA
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State | IN
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Zip | 46545-2784
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Country | US
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Telephone | 574-254-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 56930 WILD HEATHER DR
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City | SOUTH BEND
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State | IN
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Zip | 46619-9476
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Country | US
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Telephone | 574-289-4986
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 28187181A
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License Number State | IN
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