Provider Demographics
NPI:1962179614
Name:MAHONEY, SARAH ASHLEY (DNP, RN, PNP-PC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ASHLEY
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:DNP, RN, PNP-PC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5608 ADELAIDE DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-2008
Mailing Address - Country:US
Mailing Address - Phone:419-320-0688
Mailing Address - Fax:
Practice Address - Street 1:3901 BEAUBIEN STREET
Practice Address - Street 2:SUITE H
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-966-8341
Practice Address - Fax:313-966-6121
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH202018563363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics