Provider Demographics
NPI:1750808333
Name:HOUSE, SARAH ETHRIDGE (PA-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ETHRIDGE
Last Name:HOUSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:BETH
Other - Last Name:ETHRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2550 SAMARITAN DR STE 221
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-1170
Mailing Address - Country:US
Mailing Address - Phone:575-525-3535
Mailing Address - Fax:
Practice Address - Street 1:2550 SAMARITAN DR STE 221
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1170
Practice Address - Country:US
Practice Address - Phone:575-525-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty