Provider Demographics
NPI:1881394401
Name:DIRKS, SARAH ANN (NP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:DIRKS
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 1:158 SAWGRASS DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4648
Mailing Address - Country:US
Mailing Address - Phone:585-262-9150
Mailing Address - Fax:
Practice Address - Street 1:158 SAWGRASS DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:NY
Practice Address - Zip Code:14620-4648
Practice Address - Country:US
Practice Address - Phone:585-262-9150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1358853163W00000X
NYF351555-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse