Provider Demographics
NPI:1316505209
Name:LOBURAK, SAGAN MALLORY (RN BSN)
Entity type:Individual
Prefix:
First Name:SAGAN
Middle Name:MALLORY
Last Name:LOBURAK
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 W LEHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-3943
Mailing Address - Country:US
Mailing Address - Phone:215-262-8450
Mailing Address - Fax:
Practice Address - Street 1:47 W LEHMAN AVE
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-3943
Practice Address - Country:US
Practice Address - Phone:215-262-8450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN632858163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse