Provider Demographics
NPI:1497734339
Name:CONNOR, SARA N (NP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:N
Last Name:CONNOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-852-0600
Mailing Address - Fax:508-363-6080
Practice Address - Street 1:25 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604
Practice Address - Country:US
Practice Address - Phone:508-852-0600
Practice Address - Fax:508-363-6080
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158993363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NP3271OtherBLUE SHIELD HMO BLUE
NP3271OtherBLUE SHIELD INDEMNITY
8301268OtherEVERCARE
AA3636OtherHARVARD PILGRIM HEALTHCAR
042472266OtherTHREE RIVERS
042472266039OtherTRICARE CHAMPUS
NP0885OtherMEDICARE B
54436OtherFALLON COMM. HEALTH PLAN
NP3271OtherBLUE CARE ELECT
54436OtherFALLON COMM. HEALTH PLAN
NP0885OtherMEDICARE B