Basic Information
Provider Information
NPI: 1124672167
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JARRETT
FirstName: SARAH
MiddleName: BURT
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: BURT
OtherFirstName: SARAH
OtherMiddleName: EMILY
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 93 HINTZ DR
Address2:  
City: WALLINGFORD
State: CT
PostalCode: 064922001
CountryCode: US
TelephoneNumber: 2036232808
FaxNumber:  
Practice Location
Address1: 34 MAPLE ST
Address2:  
City: NORWALK
State: CT
PostalCode: 068503894
CountryCode: US
TelephoneNumber: 2038522000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/29/2019
LastUpdateDate: 07/29/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WE0003X116135CTY Nursing Service ProvidersRegistered NurseEmergency

No ID Information.


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