Provider Demographics
NPI:1790192052
Name:SURPRENANT, SARAH ALEXANDRA
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ALEXANDRA
Last Name:SURPRENANT
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 1:62 CHARLOTTE ST
Mailing Address - Street 2:#2
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-1228
Mailing Address - Country:US
Mailing Address - Phone:508-212-6410
Mailing Address - Fax:
Practice Address - Street 1:62 CHARLOTTE ST
Practice Address - Street 2:#2
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-1228
Practice Address - Country:US
Practice Address - Phone:508-212-6410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program