Provider Demographics
NPI:1821443664
Name:RODEWALD, SARAH J (NP-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:J
Last Name:RODEWALD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:ENON
Mailing Address - State:OH
Mailing Address - Zip Code:45323-0339
Mailing Address - Country:US
Mailing Address - Phone:937-864-7363
Mailing Address - Fax:937-864-5895
Practice Address - Street 1:7790 DAYTON SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-1996
Practice Address - Country:US
Practice Address - Phone:937-864-7363
Practice Address - Fax:937-864-5895
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18451-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner