Provider Demographics
NPI:1740263102
Name:MAKIELSKI, SARA JANE (CRNA)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JANE
Last Name:MAKIELSKI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:JANE
Other - Last Name:MARION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1001 SUNFLOWER TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-2783
Mailing Address - Country:US
Mailing Address - Phone:512-656-6251
Mailing Address - Fax:
Practice Address - Street 1:1001 SUNFLOWER TRL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-2783
Practice Address - Country:US
Practice Address - Phone:512-656-6251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2010-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54544367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82769UOtherBC/BS
TX159222201Medicaid
TX159222201Medicaid
TX82769UOtherBC/BS