Provider Demographics
NPI:1417371485
Name:MCKINZIE, SARA E (FNP-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:MCKINZIE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 HAWTHORN RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-1028
Mailing Address - Country:US
Mailing Address - Phone:618-548-4545
Mailing Address - Fax:618-548-4577
Practice Address - Street 1:1275 HAWTHORN RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-1028
Practice Address - Country:US
Practice Address - Phone:618-548-4545
Practice Address - Fax:618-548-4577
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011044363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner