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General NPI Number Information
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NPI Number | 1952398729
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Entity Type | Individual
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Provider Name | SAGE E BROOK CNM
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Gender | Female
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Dates
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Enumeration Date | 10/05/2005
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Last Update Date | 10/25/2020
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Provider Practice Location Address
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Address Line | 325 HAWTHORNE LN
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City | CHARLOTTE
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State | NC
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Zip | 28204-2535
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Country | US
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Telephone | 704-973-2106
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Fax | 704-973-2395
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Provider Business Mailing Address
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Address Line | PO BOX 601067
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City | CHARLOTTE
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State | NC
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Zip | 28260-1067
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Country | US
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Telephone | 704-512-5100
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Fax | 704-512-5101
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 126103
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 126103
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 123103
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 104
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License Number State | NC
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