=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861153025
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH CAROLINE GLOMBOWSKI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2022
-----------------------------------------------------
Last Update Date | 01/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3018 PEEVEY CREEK LANE
-----------------------------------------------------
City | OWENS CROSS ROADS
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-541-5252
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3018 PEEVEY CREEK LANE
-----------------------------------------------------
City | OWENS CROSS ROADS
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-541-5252
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1-153982
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------