Provider Demographics
NPI:1912969668
Name:STREET TAYLOR, SARAH (NP, RN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:STREET TAYLOR
Suffix:
Gender:F
Credentials:NP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 MONUMENT SQ
Mailing Address - Street 2:P.O. BOX 1868
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4039
Mailing Address - Country:US
Mailing Address - Phone:207-874-1055
Mailing Address - Fax:207-775-4034
Practice Address - Street 1:50 MONUMENT SQ
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4039
Practice Address - Country:US
Practice Address - Phone:207-874-1055
Practice Address - Fax:207-775-4034
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP91034363LP0808X
MERN43972163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MENP3725Medicare PIN
MEP53091Medicare UPIN
MENP372505Medicare PIN
MEE400172021Medicare PIN