Provider Demographics
NPI:1669023875
Name:NASON, SALLY JANE
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:JANE
Last Name:NASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 RAELEEN LN
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-4411
Mailing Address - Country:US
Mailing Address - Phone:207-883-5821
Mailing Address - Fax:
Practice Address - Street 1:617 RAELEEN LN
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-4411
Practice Address - Country:US
Practice Address - Phone:207-883-5821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-28
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty