Provider Demographics
NPI:1205222155
Name:EMM, SARAH ASHLEY (LPN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ASHLEY
Last Name:EMM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 FERGERSON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-2269
Mailing Address - Country:US
Mailing Address - Phone:315-807-4283
Mailing Address - Fax:
Practice Address - Street 1:424 FERGERSON AVE
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-2269
Practice Address - Country:US
Practice Address - Phone:315-807-4283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311598-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse