Provider Demographics
NPI:1851472146
Name:BEACHY, SARA T (RN CNP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:T
Last Name:BEACHY
Suffix:
Gender:F
Credentials:RN CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 BARBARA ST
Mailing Address - Street 2:
Mailing Address - City:LANDISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17538-1718
Mailing Address - Country:US
Mailing Address - Phone:717-517-4763
Mailing Address - Fax:
Practice Address - Street 1:350 BARBARA ST
Practice Address - Street 2:
Practice Address - City:LANDISVILLE
Practice Address - State:PA
Practice Address - Zip Code:17538-1718
Practice Address - Country:US
Practice Address - Phone:717-517-4763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704247923363L00000X
PASP009945363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P08820Medicare ID - Type Unspecified
P08820002Medicare ID - Type Unspecified