Provider Demographics
NPI:1104597681
Name:BURRUS, SARAH M (LPN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:BURRUS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:M
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 136
Mailing Address - Street 2:
Mailing Address - City:NUNDA
Mailing Address - State:NY
Mailing Address - Zip Code:14517-0136
Mailing Address - Country:US
Mailing Address - Phone:585-519-7462
Mailing Address - Fax:
Practice Address - Street 1:39 EAST STREET
Practice Address - Street 2:
Practice Address - City:NUNDA
Practice Address - State:NY
Practice Address - Zip Code:14517
Practice Address - Country:US
Practice Address - Phone:585-519-7462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322024164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse