MEDICARE: MRS. SARA PFEIFFER RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	28115685A	IN

General Provider Information

NPI Number	:	1336203462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARA PFEIFFER RN

Provider Business Mailing Address
First Line	:	920 W COUNTY LINE RD N
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-9120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 W COUNTY LINE RD N
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-9120
Country	:	US
Telephone Number	:	260-625-4626
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	07/08/2007

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