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General NPI Number Information
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NPI Number | 1952391435
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Entity Type | Individual
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Provider Name | SARAH BLACK WIESENDANGER PATTON PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/25/2005
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Last Update Date | 04/03/2023
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Provider Practice Location Address
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Address Line | 1601 CONGRESS ST
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City | PORTLAND
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State | ME
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Zip | 04102-2102
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Country | US
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Telephone | 207-661-0100
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Fax | 207-661-0199
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Provider Business Mailing Address
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Address Line | 23 ROSEMARY LN
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City | FREEPORT
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State | ME
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Zip | 04032-6034
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Country | US
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Telephone | 206-450-1361
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Fax | 206-346-6022
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA10005002
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2186
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License Number State | ME
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