Provider Demographics
NPI:1689849754
Name:MINARICK, SARAH C (PA)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:C
Last Name:MINARICK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:C
Other - Last Name:HEACOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 6068
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-0068
Mailing Address - Country:US
Mailing Address - Phone:402-484-9009
Mailing Address - Fax:402-483-4223
Practice Address - Street 1:7100 STEPHANIE LANE
Practice Address - Street 2:STE #100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5332
Practice Address - Country:US
Practice Address - Phone:402-484-9009
Practice Address - Fax:402-483-4223
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1362363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47065843713Medicaid