Provider Demographics
NPI:1477240604
Name:WALTERS, SARA ANN
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ANN
Last Name:WALTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:ANN
Other - Last Name:CRILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:394 GAME RESERVE RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16002-9309
Mailing Address - Country:US
Mailing Address - Phone:724-234-7102
Mailing Address - Fax:
Practice Address - Street 1:394 GAME RESERVE RD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16002-9309
Practice Address - Country:US
Practice Address - Phone:724-234-7102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily