Provider Demographics
NPI:1790388171
Name:MCPHERSON, SARA EMILY (CRNA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:EMILY
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5703 RED BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TIMNATH
Mailing Address - State:CO
Mailing Address - Zip Code:80547-2286
Mailing Address - Country:US
Mailing Address - Phone:303-332-5684
Mailing Address - Fax:
Practice Address - Street 1:3702 AUTOMATION WAY
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5737
Practice Address - Country:US
Practice Address - Phone:970-922-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1631659163W00000X
COAPN.0996171-CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse