MEDICARE: SARA J WHITLOCK CFNP

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	363LF0000X	Family Nurse Practitioner	APRNCNP05411	OH

General Provider Information

NPI Number	:	1710153556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA J WHITLOCK CFNP

Provider Business Mailing Address
First Line	:	247 NORTHVIEW RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45419-3342
Country	:	US
Telephone Number	:	937-299-3250
Fax Number	:

Provider Business Practice Location Address
First Line	:	2912 SPRINGBORO W STE 201
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1674
Country	:	US
Telephone Number	:	937-297-8999
Fax Number	:

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

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	11/02/2023

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