Provider Demographics
NPI:1750335212
Name:DEVORE, SARAH RAE (ARNP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:RAE
Last Name:DEVORE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:RAE
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 1ST ST E
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-3155
Mailing Address - Country:US
Mailing Address - Phone:319-332-0999
Mailing Address - Fax:
Practice Address - Street 1:1600 1ST ST E
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-3155
Practice Address - Country:US
Practice Address - Phone:319-332-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA103990363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0450155Medicaid
IA36112OtherWELLMARK INS PLAN
IA421417307H9OtherJOHN DEERE HEALTH INS
IA36112OtherWELLMARK INS PLAN
IAI10805Medicare ID - Type Unspecified