Provider Demographics
NPI:1861133746
Name:NOLDER, SARAH A (FNP-C)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:A
Last Name:NOLDER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:990 SOUTH AVENUE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2740
Mailing Address - Country:US
Mailing Address - Phone:585-256-3000
Mailing Address - Fax:585-256-3045
Practice Address - Street 1:990 SOUTH AVENUE
Practice Address - Street 2:SUITE 104
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2740
Practice Address - Country:US
Practice Address - Phone:585-256-3000
Practice Address - Fax:585-256-3045
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348505363LF0000X
NYF348505-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07145999Medicaid