Provider Demographics
NPI:1265940415
Name:BLANKENHEIMER, SARAH (FNP-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BLANKENHEIMER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:BUKSHPAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2451 E BASELINE RD STE 425
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-0049
Mailing Address - Country:US
Mailing Address - Phone:480-494-2770
Mailing Address - Fax:
Practice Address - Street 1:2451 E BASELINE RD STE 425
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-0049
Practice Address - Country:US
Practice Address - Phone:480-494-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN168011163W00000X
AZAP11211363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse