Provider Demographics
NPI:1205380524
Name:DEFURIO, SARA K (NP-C)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:K
Last Name:DEFURIO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 LOCUST DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-7801
Mailing Address - Country:US
Mailing Address - Phone:563-505-0022
Mailing Address - Fax:
Practice Address - Street 1:2346 MORMON TREK BLVD
Practice Address - Street 2:STE. 1500
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-4371
Practice Address - Country:US
Practice Address - Phone:319-337-7642
Practice Address - Fax:319-339-1449
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA109260363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily