Provider Demographics
NPI:1467099069
Name:CHAMPAGNE, SARA A (RN)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:A
Last Name:CHAMPAGNE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:A
Other - Last Name:HERTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:175 CONNORS ST STE 2
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-2637
Mailing Address - Country:US
Mailing Address - Phone:978-878-8446
Mailing Address - Fax:978-410-6102
Practice Address - Street 1:175 CONNORS ST STE 2
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-2637
Practice Address - Country:US
Practice Address - Phone:978-878-8446
Practice Address - Fax:978-410-6102
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2270444163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse