Provider Demographics
NPI:1013924224
Name:BRAINERD, SARA ELIZABETH (NP-C)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ELIZABETH
Last Name:BRAINERD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1310 S LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-3076
Mailing Address - Country:US
Mailing Address - Phone:765-482-7005
Mailing Address - Fax:765-483-2517
Practice Address - Street 1:1310 LEBANON STREET
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-3076
Practice Address - Country:US
Practice Address - Phone:765-482-7005
Practice Address - Fax:765-483-2517
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INAG06210272363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100270530AMedicaid