Provider Demographics
NPI:1467981118
Name:HESS, SARA LEE (NP-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LEE
Last Name:HESS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:LEE
Other - Last Name:THOBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2400
Mailing Address - Country:US
Mailing Address - Phone:419-394-3387
Mailing Address - Fax:419-628-9501
Practice Address - Street 1:4463 STATE ROUTE 66
Practice Address - Street 2:
Practice Address - City:MINSTER
Practice Address - State:OH
Practice Address - Zip Code:45865-8727
Practice Address - Country:US
Practice Address - Phone:419-628-3821
Practice Address - Fax:419-628-9501
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020961363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9934723OtherMEDICARE GROUP PTAN
OH0105065OtherJTDM FAMILY PRACTICE LLC - GROUP MEDICAID
OH0229424Medicaid
OH34-1689161OtherJTDM FAMILY PRACTICE LLC - TAX ID
OHH602800OtherMEDICARE PATN
OH1184652539OtherJTDM FAMILY PRACTICE, LLC GROUP NPI