Basic Information
| Provider Information | |||||||||
| NPI: | 1922294909 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARREN | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 EXECUTIVE CIR | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314063345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9126911533 | ||||||||
| FaxNumber: | 9126911953 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 EXECUTIVE CIR | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314063345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9126911533 | ||||||||
| FaxNumber: | 9126911953 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2007 | ||||||||
| LastUpdateDate: | 05/23/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN127202 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 01161143 | 01 | GA | AMERIGROUP | OTHER | 369309425B | 05 | GA | MEDICAID | RN127202 | 01 | GA | STATE LICENSE | OTHER | 369309425A | 05 | GA | MEDICAID | NP1169 | 05 | SC | MEDICAID |