Provider Demographics
NPI:1336825314
Name:PRALL, SADIE ROSE
Entity Type:Individual
Prefix:
First Name:SADIE
Middle Name:ROSE
Last Name:PRALL
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 1:3022 116TH STREET
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43611
Mailing Address - Country:US
Mailing Address - Phone:215-353-8160
Mailing Address - Fax:
Practice Address - Street 1:3022 116TH STREET
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43611
Practice Address - Country:US
Practice Address - Phone:215-353-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHVG697304172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver