Provider Demographics
NPI:1760760201
Name:GLOVER, SARA COLETTE (PA-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:COLETTE
Last Name:GLOVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:COLETTE
Other - Last Name:SEFCIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9146 LINDEN DR
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1683
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6000 UNIVERSITY AVE STE 124
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8200
Practice Address - Country:US
Practice Address - Phone:515-241-2020
Practice Address - Fax:515-241-2040
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002205363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant