Provider Demographics
NPI:1518379064
Name:HAUN, SARAH ANN (NP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:HAUN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:BREHM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4160 LITTLE YORK RD
Mailing Address - Street 2:STE 10
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-5803
Mailing Address - Country:US
Mailing Address - Phone:937-415-9137
Mailing Address - Fax:937-415-9137
Practice Address - Street 1:4160 LITTLE YORK RD
Practice Address - Street 2:STE 10
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-5803
Practice Address - Country:US
Practice Address - Phone:937-415-9137
Practice Address - Fax:937-415-9137
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.15915-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSJ100646OtherDRIVER'S LICENSE
OH0107035Medicaid
OHH330000OtherMEDICARE PTAN
OHH330000OtherMEDICARE PTAN