MEDICARE: SARAH CHURBA NP

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	363L00000X	Nurse Practitioner	347141	NY

General Provider Information

NPI Number	:	1841882990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH CHURBA NP

Provider Business Mailing Address
First Line	:	1417 E 9TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6404
Country	:	US
Telephone Number	:	718-909-9942
Fax Number	:

Provider Business Practice Location Address
First Line	:	1417 E 9TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6404
Country	:	US
Telephone Number	:	718-909-9942
Fax Number	:

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

Provider Enumeration Date	:	02/10/2021
Last Update Date	:	02/10/2021

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