Provider Demographics
NPI:1831190073
Name:O'CONNOR, SARA L (CRNA)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:L
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:L
Other - Last Name:GRZESKOWIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 224047
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-4047
Mailing Address - Country:US
Mailing Address - Phone:844-565-6466
Mailing Address - Fax:302-709-2402
Practice Address - Street 1:2704 N GALLOWAY AVE STE 102
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6379
Practice Address - Country:US
Practice Address - Phone:972-961-7171
Practice Address - Fax:636-537-0480
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139239367500000X
MO094025367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO912804358Medicaid