Provider Demographics
NPI:1225181910
Name:BANSEN, SARAH (APRN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BANSEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 HIGHLAND AVE
Mailing Address - Street 2:WOMEN'S HEALTH CENTER
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-1408
Mailing Address - Country:US
Mailing Address - Phone:617-591-4800
Mailing Address - Fax:
Practice Address - Street 1:230 HIGHLAND AVE
Practice Address - Street 2:WOMEN'S HEALTH CENTER
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-1408
Practice Address - Country:US
Practice Address - Phone:617-591-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA191207363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110076816AMedicaid
MA110076816AMedicaid
S74055Medicare UPIN