Provider Demographics
NPI:1831113042
Name:POWELL, SARA P (CRNA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:P
Last Name:POWELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ORRINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04474-3604
Mailing Address - Country:US
Mailing Address - Phone:207-852-9137
Mailing Address - Fax:
Practice Address - Street 1:881 RIVER RD
Practice Address - Street 2:
Practice Address - City:ORRINGTON
Practice Address - State:ME
Practice Address - Zip Code:04474-3604
Practice Address - Country:US
Practice Address - Phone:207-852-9137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24786163W00000X
ME30595367500000X
MERNA173007367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ275473662Medicare PIN
SCQ27547Medicare UPIN