Provider Demographics
NPI:1073163267
Name:WARE, SARAH (PN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:WARE
Suffix:
Gender:F
Credentials:PN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-0459
Mailing Address - Country:US
Mailing Address - Phone:573-756-5749
Mailing Address - Fax:
Practice Address - Street 1:1565 SAINTE GENEVIEVE AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3454
Practice Address - Country:US
Practice Address - Phone:573-756-5749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015038661164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse