Provider Demographics
NPI:1003645938
Name:KOVALCHIK, SARA ELIZABETH (CRNP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ELIZABETH
Last Name:KOVALCHIK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 ARNOLD DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON TWP
Mailing Address - State:PA
Mailing Address - Zip Code:18436-3256
Mailing Address - Country:US
Mailing Address - Phone:570-687-8149
Mailing Address - Fax:
Practice Address - Street 1:247 MAIN ST
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1641
Practice Address - Country:US
Practice Address - Phone:570-291-4180
Practice Address - Fax:570-586-3953
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP030133363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily