Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 0027131 | OH |
NPI | 1003489378 |
---|---|
Provider Name | Sara Youngblood |
First Address | Berea, OH 44017-2650 |
Second Address | Berea, OH 44017-2650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2021 |
Last Update Date | 23/07/2021 |