Provider Demographics
NPI:1497451199
Name:POPA, SALLY MARIE
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:MARIE
Last Name:POPA
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 1:211 WHIELDON LN
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2904
Mailing Address - Country:US
Mailing Address - Phone:614-314-1147
Mailing Address - Fax:
Practice Address - Street 1:211 WHIELDON LN
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2904
Practice Address - Country:US
Practice Address - Phone:614-314-1147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide