Provider Demographics
NPI:1457665754
Name:BAXLEY, SARA
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:BAXLEY
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 1:4576 N MARSHAL TRL
Mailing Address - Street 2:
Mailing Address - City:ENOCH
Mailing Address - State:UT
Mailing Address - Zip Code:84721-9601
Mailing Address - Country:US
Mailing Address - Phone:435-704-4137
Mailing Address - Fax:
Practice Address - Street 1:170 E ALTAMIRA DR
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-3509
Practice Address - Country:US
Practice Address - Phone:435-704-4137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other