Provider Demographics
NPI:1962456202
Name:WALLINGFORD, SARAH BAUGHER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:BAUGHER
Last Name:WALLINGFORD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17160 MIDDLE LN
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-6572
Mailing Address - Country:US
Mailing Address - Phone:402-517-1491
Mailing Address - Fax:
Practice Address - Street 1:17160 MIDDLE LN
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-6572
Practice Address - Country:US
Practice Address - Phone:402-517-1491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1101363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q04902Medicare UPIN
NE277219Medicare PIN