Provider Demographics
NPI:1508622630
Name:JESSUP VANZOMEREN, SARAH (MA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:JESSUP VANZOMEREN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SARAH CARTER
Other - Middle Name:
Other - Last Name:JESSUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 MILL ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1048
Mailing Address - Country:US
Mailing Address - Phone:336-209-2536
Mailing Address - Fax:
Practice Address - Street 1:115 MILL ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-1048
Practice Address - Country:US
Practice Address - Phone:336-209-2536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program