Provider Demographics
NPI:1922009273
Name:THEOHARIS, SARA D (CRNA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:D
Last Name:THEOHARIS
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 1:420 W 5TH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-7551
Mailing Address - Country:US
Mailing Address - Phone:402-463-9841
Mailing Address - Fax:402-463-9846
Practice Address - Street 1:715 N SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4451
Practice Address - Country:US
Practice Address - Phone:402-463-9841
Practice Address - Fax:402-463-9846
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE100659367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE08653OtherBCBS NE
NE430042816Medicare ID - Type UnspecifiedRR MEDICARE
NE08653OtherBCBS NE