Provider Demographics
NPI:1003869561
Name:CONGLETON, SARAH L (NP)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:L
Last Name:CONGLETON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:L
Other - Last Name:CONNELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1351 S COUNTY TRL
Mailing Address - Street 2:BLDG 1, SUITE 100
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5079
Mailing Address - Country:US
Mailing Address - Phone:401-886-5907
Mailing Address - Fax:401-885-6071
Practice Address - Street 1:1351 S COUNTY TRL
Practice Address - Street 2:BLDG 1, SUITE 100
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5079
Practice Address - Country:US
Practice Address - Phone:401-886-5907
Practice Address - Fax:401-885-6071
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37339363L00000X
RIRN27508163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIQ62620Medicare UPIN