Provider Demographics
NPI:1720774706
Name:KIETZMAN, SARA (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:KIETZMAN
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 DIAMOND ROCK RD
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-9514
Mailing Address - Country:US
Mailing Address - Phone:267-879-9779
Mailing Address - Fax:
Practice Address - Street 1:1355 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3413
Practice Address - Country:US
Practice Address - Phone:215-886-2433
Practice Address - Fax:215-886-2433
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN282280L163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant