Provider Demographics
NPI:1821600875
Name:KELLOGG, SARA (DNP STUDENT)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:DNP STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 E GLENN ST APT 90
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-5222
Mailing Address - Country:US
Mailing Address - Phone:520-390-7852
Mailing Address - Fax:
Practice Address - Street 1:5701 E GLENN ST APT 90
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5222
Practice Address - Country:US
Practice Address - Phone:520-390-7852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ173053163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency