Provider Demographics
NPI:1417089434
Name:SARE, STEPHANIE BETH
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BETH
Last Name:SARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 N EAST ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IN
Mailing Address - Zip Code:47460-1007
Mailing Address - Country:US
Mailing Address - Phone:812-829-2459
Mailing Address - Fax:812-828-0884
Practice Address - Street 1:650 N EAST ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IN
Practice Address - Zip Code:47460-1007
Practice Address - Country:US
Practice Address - Phone:812-829-2459
Practice Address - Fax:812-828-0884
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN750771373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist