Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 3016692 | KY |
N | 363LN0000X | Nurse Practitioner - Neonatal | 71011094A | IN |
NPI | 1033793286 |
---|---|
Provider Name | Sarah Ashley Longaker |
First Address | Fort Wayne, IN 46804-7934 |
Second Address | Lexington, KY 40536-4140 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2021 |
Last Update Date | 08/11/2021 |