Provider Demographics
NPI:1558905638
Name:BROUTY, SARAH A (RN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:BROUTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:MARMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1302 POWERHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:NY
Mailing Address - Zip Code:13112-9795
Mailing Address - Country:US
Mailing Address - Phone:315-777-2253
Mailing Address - Fax:
Practice Address - Street 1:1302 POWERHOUSE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:NY
Practice Address - Zip Code:13112-9795
Practice Address - Country:US
Practice Address - Phone:315-777-2253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY735578163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics