Provider Demographics
NPI:1528573599
Name:GERLACH, SARA LYNN (APRN-CNM)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LYNN
Last Name:GERLACH
Suffix:
Gender:F
Credentials:APRN-CNM
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:LYNN
Other - Last Name:WELLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
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:419-300-1129
Mailing Address - Fax:419-394-7313
Practice Address - Street 1:1140 S KNOXVILLE AVE STE B
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2609
Practice Address - Country:US
Practice Address - Phone:419-394-7314
Practice Address - Fax:419-394-7313
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.022184363LF0000X
OHAPRN.CNM.0019451367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0258014Medicaid
OHH669520OtherMEDICARE