Provider Demographics
NPI:1740254333
Name:WORSLEY, SARA A (PA C)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:A
Last Name:WORSLEY
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:A
Other - Last Name:SMOLINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA C
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:406 E ELM ST
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811
Mailing Address - Country:US
Mailing Address - Phone:989-584-3131
Mailing Address - Fax:989-584-6734
Practice Address - Street 1:320 S STERLING ST
Practice Address - Street 2:
Practice Address - City:ASHLEY
Practice Address - State:MI
Practice Address - Zip Code:48806
Practice Address - Country:US
Practice Address - Phone:989-847-2621
Practice Address - Fax:989-847-2008
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1152915150OtherBLUE CROSS BLUE SHIELD
MI0N61600Medicare PIN
MIM02890P16Medicare PIN
P76743Medicare UPIN