Provider Demographics
NPI:1912098328
Name:SAWYER, KATHLEEN M (APN)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:M
Last Name:SAWYER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:NEMOURS PEDIATRICS MIDDLETOWN
Practice Address - Street 2:200 CLEAVER FARM ROAD SUITE 201
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1630
Practice Address - Country:US
Practice Address - Phone:302-378-5100
Practice Address - Fax:302-378-5106
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL10021824363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8668906Medicaid
MD6994211Medicaid
MD6994211Medicaid
009357T34Medicare PIN