Provider Demographics
NPI:1679577951
Name:BUTCHER, SARAH A (CRNA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:BUTCHER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:FREYMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3122 52ND AVENUE CT
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-6952
Mailing Address - Country:US
Mailing Address - Phone:563-332-1844
Mailing Address - Fax:
Practice Address - Street 1:3400 DEXTER CT
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3461
Practice Address - Country:US
Practice Address - Phone:563-344-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD-093549367500000X
IL367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00235039OtherRAILROAD MEDICARE
IA11639OtherBLUE SHIELD
IA421374509 22OtherJOHN DEERE
IA1567677Medicaid
IAI11902Medicare ID - Type Unspecified
IAP00235039OtherRAILROAD MEDICARE
IA421374509 22OtherJOHN DEERE
IAP31214Medicare UPIN