Provider Demographics
NPI:1548511504
Name:SAGOWITZ, MILDRED LUCILLE
Entity type:Individual
Prefix:MS
First Name:MILDRED
Middle Name:LUCILLE
Last Name:SAGOWITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 HUDSON AVE
Mailing Address - Street 2:APT A
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-5787
Mailing Address - Country:US
Mailing Address - Phone:740-975-7231
Mailing Address - Fax:740-281-0028
Practice Address - Street 1:325 HUDSON AVE
Practice Address - Street 2:APT A
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5787
Practice Address - Country:US
Practice Address - Phone:740-975-7231
Practice Address - Fax:740-281-0028
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-30
Last Update Date:2012-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN117118164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse