Provider Demographics
NPI:1508217589
Name:CHANNELL, SARAH (NP-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:CHANNELL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 TIMBER TRL
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-9036
Mailing Address - Country:US
Mailing Address - Phone:937-599-3115
Mailing Address - Fax:937-599-9912
Practice Address - Street 1:2231 TIMBER TRL
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-9036
Practice Address - Country:US
Practice Address - Phone:937-599-3115
Practice Address - Fax:937-599-9912
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF06161567363LF0000X
OHAPRN.CNP.019323363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH173987Medicaid