Provider Demographics
NPI:1679338560
Name:JEPSEN, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:JEPSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W 11TH AVE UNIT 5J
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-3663
Mailing Address - Country:US
Mailing Address - Phone:314-660-4088
Mailing Address - Fax:
Practice Address - Street 1:300 W 11TH AVE UNIT 5J
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-3663
Practice Address - Country:US
Practice Address - Phone:314-660-4088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0008374363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant