Provider Demographics
NPI:1730671462
Name:UPDEGRAFF, SARAH (MPH, CRNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:UPDEGRAFF
Suffix:
Gender:F
Credentials:MPH, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 HOLLYWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3029
Mailing Address - Country:US
Mailing Address - Phone:570-971-6233
Mailing Address - Fax:
Practice Address - Street 1:495 FLATBUSH AVE STE C5
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-3706
Practice Address - Country:US
Practice Address - Phone:570-567-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018895363LF0000X
NYF347166363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily