Provider Demographics
NPI:1629213574
Name:MONTAVON, SARAH MARIE (APRN)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:MARIE
Last Name:MONTAVON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3 COLONIAL CT
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2962
Mailing Address - Country:US
Mailing Address - Phone:860-309-0401
Mailing Address - Fax:
Practice Address - Street 1:64 ROBBINS ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2613
Practice Address - Country:US
Practice Address - Phone:203-573-6232
Practice Address - Fax:203-573-6030
Is Sole Proprietor?:No
Enumeration Date:2008-12-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT072262163WC0200X
SCR 200316163WC0200X
HI62803163WC0200X
CA678517163WC0200X
CT7078363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine