Basic Information
| Provider Information | |||||||||
| NPI: | 1437139482 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOWE | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | MCCULLOCH | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4951 WILSON SHARPSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | FOWLER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444189701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068132869 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7206 MARKET ST | ||||||||
| Address2: | STE A | ||||||||
| City: | BOARDMAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445124507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307263379 | ||||||||
| FaxNumber: | 3307268683 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 01/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 4669P | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 12385 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 78015120 | 05 | KY | MEDICAID | 0054275 | 05 | OH | MEDICAID |