Provider Demographics
NPI:1225393283
Name:EISWORTH, SARAH WALLACE (NP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:WALLACE
Last Name:EISWORTH
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:2335 CHURCH ST STE E
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-2700
Mailing Address - Country:US
Mailing Address - Phone:225-570-2489
Mailing Address - Fax:225-570-2986
Practice Address - Street 1:19900 OLD SCENIC HWY
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-7368
Practice Address - Country:US
Practice Address - Phone:225-570-2618
Practice Address - Fax:225-570-8539
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2020-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA06938363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2452037Medicaid