Provider Demographics
NPI:1497989966
Name:STARK, SARA HULDA (LPN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:HULDA
Last Name:STARK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 S. AGNER ST.
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875
Mailing Address - Country:US
Mailing Address - Phone:419-969-9526
Mailing Address - Fax:
Practice Address - Street 1:1709 S AGNER ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-1613
Practice Address - Country:US
Practice Address - Phone:419-969-9526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.111715164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse