Provider Demographics
NPI:1215578521
Name:POUTASSE, SARAH M (NP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:POUTASSE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300B LAWRENCE DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4289
Mailing Address - Country:US
Mailing Address - Phone:610-836-5990
Mailing Address - Fax:610-836-5998
Practice Address - Street 1:300B LAWRENCE DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4289
Practice Address - Country:US
Practice Address - Phone:610-836-5990
Practice Address - Fax:610-836-5998
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP005582B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily