Provider Demographics
NPI:1750643706
Name:SMITH, SARAH STOLLAR (CRNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:STOLLAR
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:BROOKE
Other - Last Name:STOLLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:85 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1105
Mailing Address - Country:US
Mailing Address - Phone:781-647-7246
Mailing Address - Fax:781-290-0720
Practice Address - Street 1:85 1ST AVE
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1105
Practice Address - Country:US
Practice Address - Phone:781-647-7246
Practice Address - Fax:781-290-0720
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012138363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP012138OtherADULT NURSE PRACTITIONER LICENSE