Provider Demographics
NPI:1982091229
Name:MOSBERG, SARAH E (NP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:MOSBERG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:MARIETTA
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:400 MATTHEW ST STE 302
Practice Address - Street 2:MARIETTA
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1656
Practice Address - Country:US
Practice Address - Phone:740-568-5207
Practice Address - Fax:740-568-5297
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2016-06-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHCOA.17229-NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810028936Medicaid
OH0128144Medicaid
WV3810028936Medicaid
OHH292780Medicare PIN