Basic Information
| Provider Information | |||||||||
| NPI: | 1356814321 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATSY | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3413 CHERRY ST | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165082678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148689828 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3413 CHERRY ST | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165082678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148689828 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2019 | ||||||||
| LastUpdateDate: | 10/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA060429 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | MA060429 | 01 | PA | MEDICAL PHYSICIAN ASSISTANT LICENSE NUMBER | OTHER |