Provider Demographics
NPI:1871189944
Name:KOGUT, SARAH MARIA (RN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIA
Last Name:KOGUT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2526 E ROCKLEDGE RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-9174
Mailing Address - Country:US
Mailing Address - Phone:480-528-5622
Mailing Address - Fax:
Practice Address - Street 1:2840 N DYSART RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2338
Practice Address - Country:US
Practice Address - Phone:623-536-5310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ218292163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse