Provider Demographics
NPI:1033688924
Name:MARSO, SARA J (FNP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:J
Last Name:MARSO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 W EDGEWOOD DR STE B
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-5869
Mailing Address - Country:US
Mailing Address - Phone:573-761-0304
Mailing Address - Fax:
Practice Address - Street 1:2511 W EDGEWOOD DR STE D
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-5869
Practice Address - Country:US
Practice Address - Phone:573-761-0304
Practice Address - Fax:573-635-0726
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018040837363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily