Provider Demographics
NPI:1508184912
Name:DAMEN, SARAH REBECCA (NP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:REBECCA
Last Name:DAMEN
Suffix:
Gender:F
Credentials:NP
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 936
Mailing Address - Street 2:EVMS MEDICAL GROUP
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-7900
Mailing Address - Fax:757-446-7464
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-7900
Practice Address - Fax:757-446-7464
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN149715163W00000X
VA0024170351363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1508184912Medicaid
VA10116321NOtherOPTIMA HEALTH
VAPAROtherCORVEL
VAPAROtherMULTIPLAN
VA-010OtherTRICARE
VA1508184912OtherVIRGINIA PREMIER HEALTH PLAN
NC1508184912Medicaid
VAPAROtherUSA MANAGED CARE
NC1508184912Medicaid