1992889547 NPI number — DR. SARA THYR N.D.

Table of content: DR. SARA THYR N.D. (NPI 1992889547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992889547 NPI number — DR. SARA THYR N.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THYR
Provider First Name:
SARA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
N.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992889547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
607 ACADIA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PETALUMA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94954-6684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-781-7108
Provider Business Mailing Address Fax Number:
707-781-7108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 D ST
Provider Second Line Business Practice Location Address:
SUITE1
Provider Business Practice Location Address City Name:
PETALUMA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94952-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-780-6033
Provider Business Practice Location Address Fax Number:
707-283-0064
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  25 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175F00000X , with the licence number: ND-316 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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