Provider Demographics
NPI:1972138428
Name:SAGER, AFRAICA RENEE
Entity Type:Individual
Prefix:
First Name:AFRAICA
Middle Name:RENEE
Last Name:SAGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 HUTSON DR
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-3320
Mailing Address - Country:US
Mailing Address - Phone:573-200-1303
Mailing Address - Fax:
Practice Address - Street 1:20 S SPRIGG ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-6212
Practice Address - Country:US
Practice Address - Phone:573-651-4177
Practice Address - Fax:573-651-3636
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-10-06
Deactivation Date:2020-08-29
Deactivation Code:
Reactivation Date:2020-10-06
Provider Licenses
StateLicense IDTaxonomies
MO261QR0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care