MEDICARE: SARAH NICHOLE NOPPEN D.O.

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	207V00000X	Obstetrics & Gynecology Physician	5101020048	MI
2	207V00000X	Obstetrics & Gynecology Physician	20A18175	CA

General Provider Information

NPI Number	:	1649533274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH NICHOLE NOPPEN D.O.

Provider Business Mailing Address
First Line	:	19341 BEAR VALLEY RD STE 105
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92308-5152
Country	:	US
Telephone Number	:	760-247-6444
Fax Number	:	760-947-5619

Provider Business Practice Location Address
First Line	:	19341 BEAR VALLEY RD STE 105
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92308-5152
Country	:	US
Telephone Number	:	760-247-6444
Fax Number	:	760-947-5619

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

Provider Enumeration Date	:	06/19/2012
Last Update Date	:	10/15/2020

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