Provider Demographics
NPI:1043869266
Name:MOLDOVAN, SARAH SUZANNE (STNA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:SUZANNE
Last Name:MOLDOVAN
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 OAK MANOR AVE NE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-4032
Mailing Address - Country:US
Mailing Address - Phone:330-844-9753
Mailing Address - Fax:
Practice Address - Street 1:368 OAK MANOR AVE NE
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-4032
Practice Address - Country:US
Practice Address - Phone:330-844-9753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401927100117376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide