Provider Demographics
NPI:1457839896
Name:SANG, NOAH KIPKORIR (AGACNP, FNP)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:KIPKORIR
Last Name:SANG
Suffix:
Gender:M
Credentials:AGACNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 N IRONWOOD DR STE 112
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85120-3830
Mailing Address - Country:US
Mailing Address - Phone:480-992-1455
Mailing Address - Fax:480-992-5477
Practice Address - Street 1:105 S DELAWARE DR STE 2
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-6512
Practice Address - Country:US
Practice Address - Phone:480-646-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-28
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11440363LA2100X
AZAP11415363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care