Basic Information
Provider Information
NPI: 1922619246
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FREBURGER
FirstName: SARAH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 333 N SUMMIT ST
Address2:  
City: TOLEDO
State: OH
PostalCode: 436042615
CountryCode: US
TelephoneNumber: 8005645952
FaxNumber: 8005645952
Practice Location
Address1: 4669 FALLS RD
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212094914
CountryCode: US
TelephoneNumber: 8004271902
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/11/2020
LastUpdateDate: 08/11/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/11/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X2020014100MDY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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