Provider Demographics
NPI:1942702675
Name:BAKURA, SARAH JANE LORRAINE (MS PPC)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JANE LORRAINE
Last Name:BAKURA
Suffix:
Gender:F
Credentials:MS PPC
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:JANE LORRAINE
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS PPC
Mailing Address - Street 1:PO BOX 222
Mailing Address - Street 2:
Mailing Address - City:SINCLAIR
Mailing Address - State:WY
Mailing Address - Zip Code:82334-0222
Mailing Address - Country:US
Mailing Address - Phone:307-421-0619
Mailing Address - Fax:
Practice Address - Street 1:402 N 9TH ST
Practice Address - Street 2:
Practice Address - City:SINCLAIR
Practice Address - State:WY
Practice Address - Zip Code:82334-5027
Practice Address - Country:US
Practice Address - Phone:307-421-0619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 390200000X
WYPPC-1125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program