Provider Demographics
NPI:1700106218
Name:BURCHAM, SARA (PA-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BURCHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2577 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5919
Mailing Address - Country:US
Mailing Address - Phone:970-247-8382
Mailing Address - Fax:970-512-7144
Practice Address - Street 1:604 S RIO GRANDE AVE
Practice Address - Street 2:
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-2260
Practice Address - Country:US
Practice Address - Phone:505-334-2664
Practice Address - Fax:505-334-7759
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06228363AM0700X
COPA.0005385363AM0700X
NMPA2018-0040363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical