Provider Demographics
NPI:1982610036
Name:DIETER, SARA JOAN (PAC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JOAN
Last Name:DIETER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:JOAN
Other - Last Name:BRADT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 ANGLERS DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8836
Mailing Address - Country:US
Mailing Address - Phone:970-871-0000
Mailing Address - Fax:970-870-1400
Practice Address - Street 1:505 ANGLERS DR
Practice Address - Street 2:SUITE 202
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8836
Practice Address - Country:US
Practice Address - Phone:970-871-0000
Practice Address - Fax:970-870-1400
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1480OtherCO STATE LIC
CO81776535Medicaid
CO81776535Medicaid
P60243Medicare UPIN
CO81776535Medicaid