=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912407875
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH M BLOOD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2018
-----------------------------------------------------
Last Update Date | 02/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 282 FARMERS ROW
-----------------------------------------------------
City | GROTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01450-1848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-448-7666
-----------------------------------------------------
Fax | 978-448-7241
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 192 PAGE HILL RD
-----------------------------------------------------
City | NEW IPSWICH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03071-3918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-878-4752
-----------------------------------------------------
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 | 056474-23
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QS1000X
-----------------------------------------------------
Taxonomy Name | Student Health Clinic/Center
-----------------------------------------------------
License Number | RN265036
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------