Individual
MRS. SARAH BLACK WIESENDANGER PATTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1601 CONGRESS ST, PORTLAND, ME 04102-2102
(207) 661-0100
(207) 661-0199
Mailing address
23 ROSEMARY LN, FREEPORT, ME 04032-6034
(206) 450-1361
(206) 346-6022
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2186
ME
363AM0700X
Medical Physician Assistant
PA10005002
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1551PA
BLUE CROSS BLUE SHEILD
WA
Enumeration date
10/25/2005
Last updated
04/03/2023
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