Provider Demographics
NPI:1457578759
Name:BAUTZ, SARA K (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:K
Last Name:BAUTZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:K
Other - Last Name:MUNYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:2360 E PERSHING BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-5356
Mailing Address - Country:US
Mailing Address - Phone:307-778-7550
Mailing Address - Fax:307-778-7504
Practice Address - Street 1:2360 E PERSHING BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5356
Practice Address - Country:US
Practice Address - Phone:307-778-7550
Practice Address - Fax:307-778-7504
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2667363LF0000X
WY27933.1040363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily