Provider Demographics
NPI:1427203181
Name:CHURCH, SARA ELEANOR (CNM)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ELEANOR
Last Name:CHURCH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 STEVENS ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3859
Mailing Address - Country:US
Mailing Address - Phone:203-852-3073
Mailing Address - Fax:
Practice Address - Street 1:30 STEVENS ST
Practice Address - Street 2:SUITE B
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3859
Practice Address - Country:US
Practice Address - Phone:203-852-3073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-22
Last Update Date:2008-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000328367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife