Provider Demographics
NPI:1053663641
Name:OLIVER, SARAH ELOISE (PA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELOISE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:150 S MOUNT AUBURN RD
Practice Address - Street 2:SUITE 342
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4911
Practice Address - Country:US
Practice Address - Phone:573-331-5677
Practice Address - Fax:573-331-5678
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2021-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2012035061363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant