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General NPI Number Information
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NPI Number | 1972219178
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Entity Type | Individual
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Provider Name | SARAH MCMAHON FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/30/2023
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Last Update Date | 03/31/2023
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Provider Practice Location Address
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Address Line | 100 NAVARRE PL STE 5550
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City | SOUTH BEND
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State | IN
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Zip | 46601-1169
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Country | US
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Telephone | 574-647-2550
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Fax |
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Provider Business Mailing Address
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Address Line | 3245 HEALTH DR STE 100
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City | GRANGER
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State | IN
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Zip | 46530-1380
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Country | US
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Telephone | 574-647-1840
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 28223112A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71013594A
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License Number State | IN
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