Provider Demographics
NPI:1215363171
Name:SARA S STIVELMAN CRNA, INC.
Entity type:Organization
Organization Name:SARA S STIVELMAN CRNA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIA PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:SEIDEL
Authorized Official - Last Name:STIVELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:410-219-3836
Mailing Address - Street 1:1809 W CLEAR LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1969
Mailing Address - Country:US
Mailing Address - Phone:410-219-3836
Mailing Address - Fax:
Practice Address - Street 1:1414 S SALISBURY BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:410-749-1191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD047138367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty