Provider Demographics
NPI:1255850822
Name:WESTPHAL, SARA MARIE
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:WESTPHAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 JIMAL DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-3656
Mailing Address - Country:US
Mailing Address - Phone:845-775-8074
Mailing Address - Fax:
Practice Address - Street 1:129 JIMAL DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-3656
Practice Address - Country:US
Practice Address - Phone:845-775-8074
Practice Address - Fax:845-775-8074
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY329506-1164W00000X
NY870630-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical Nurse