Provider Demographics
NPI:1770808800
Name:HALE, SARA E
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:HALE
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 1:4781 FORD RD
Mailing Address - Street 2:
Mailing Address - City:ELBA
Mailing Address - State:NY
Mailing Address - Zip Code:14058-9505
Mailing Address - Country:US
Mailing Address - Phone:585-297-9854
Mailing Address - Fax:
Practice Address - Street 1:2560 WALDEN AVE
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4757
Practice Address - Country:US
Practice Address - Phone:716-683-5202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261893-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse