Provider Demographics
NPI:1528209038
Name:GLOUSE, SARAH LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNN
Last Name:GLOUSE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7878 LEWIS RD
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13309-4116
Mailing Address - Country:US
Mailing Address - Phone:315-942-4847
Mailing Address - Fax:315-942-4847
Practice Address - Street 1:7878 LEWIS RD
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:NY
Practice Address - Zip Code:13309-4116
Practice Address - Country:US
Practice Address - Phone:315-942-4847
Practice Address - Fax:315-942-4847
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288606164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse