Provider Demographics
NPI:1639154016
Name:DOUGLAS, SARA (NP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:DOUGLAS
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 1:226 BLUEBELL RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-6328
Mailing Address - Country:US
Mailing Address - Phone:319-575-5800
Mailing Address - Fax:319-575-5855
Practice Address - Street 1:226 BLUEBELL RD
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-6328
Practice Address - Country:US
Practice Address - Phone:319-575-5800
Practice Address - Fax:319-575-5855
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-084442363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0076372Medicaid
IA16923Medicare ID - Type Unspecified
IAP01713Medicare UPIN