Provider Demographics
NPI:1477577336
Name:MAHONY, SARA DAWN (PA-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:DAWN
Last Name:MAHONY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX F
Mailing Address - Street 2:
Mailing Address - City:SAINT EDWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68660-0167
Mailing Address - Country:US
Mailing Address - Phone:402-678-2232
Mailing Address - Fax:402-678-2234
Practice Address - Street 1:1102 WATER ST
Practice Address - Street 2:
Practice Address - City:SAINT EDWARD
Practice Address - State:NE
Practice Address - Zip Code:68660-4478
Practice Address - Country:US
Practice Address - Phone:402-678-2232
Practice Address - Fax:402-678-2234
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE721363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NES71691Medicare UPIN