Provider Demographics
NPI:1922288687
Name:LINSTROM, SARA LYNN (APRN)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:LYNN
Last Name:LINSTROM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:LYNN
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 950204
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0204
Mailing Address - Country:US
Mailing Address - Phone:502-425-9138
Mailing Address - Fax:502-425-9161
Practice Address - Street 1:9720 PARK PLAZA AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2288
Practice Address - Country:US
Practice Address - Phone:502-425-9138
Practice Address - Fax:502-425-9161
Is Sole Proprietor?:No
Enumeration Date:2007-11-10
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005396363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100067500Medicaid