Provider Demographics
NPI:1871009886
Name:DOW, SAGE KENYON (CNP)
Entity Type:Individual
Prefix:
First Name:SAGE
Middle Name:KENYON
Last Name:DOW
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:SAGE
Other - Middle Name:COLIN
Other - Last Name:KENYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:125 LIBERTY ST
Mailing Address - Street 2:STE 205
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1109
Mailing Address - Country:US
Mailing Address - Phone:413-271-7136
Mailing Address - Fax:413-271-7137
Practice Address - Street 1:3300 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1112
Practice Address - Country:US
Practice Address - Phone:413-794-7552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2268672363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily