Provider Demographics
NPI:1619638293
Name:CEDAR SAGE PLLC
Entity Type:Organization
Organization Name:CEDAR SAGE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCK
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:319-415-4728
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:FAIRBANK
Mailing Address - State:IA
Mailing Address - Zip Code:50629-0026
Mailing Address - Country:US
Mailing Address - Phone:319-415-4728
Mailing Address - Fax:
Practice Address - Street 1:143 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:IA
Practice Address - Zip Code:52142-7701
Practice Address - Country:US
Practice Address - Phone:319-415-4728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty