Provider Demographics
NPI:1245302611
Name:HENRY, SARAH A (NP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:HENRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:MARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2529
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:
Practice Address - Street 1:611 W PARK ST
Practice Address - Street 2:NEUROSCIENCES
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2529
Practice Address - Country:US
Practice Address - Phone:217-383-3440
Practice Address - Fax:217-326-0160
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003883363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ05320Medicare UPIN
ILIL3270254Medicare PIN
Q05320Medicare UPIN
IL6447860011Medicare NSC