Provider Demographics
NPI:1790032332
Name:HERTZKE-HILL, SARA E (PA-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:HERTZKE-HILL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S ASH ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MO
Mailing Address - Zip Code:65622-8674
Mailing Address - Country:US
Mailing Address - Phone:417-345-6100
Mailing Address - Fax:
Practice Address - Street 1:201 S ASH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MO
Practice Address - Zip Code:65622
Practice Address - Country:US
Practice Address - Phone:417-345-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012023814363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant