1528363827 NPI number — SARA JEAN ENYART PA-C

Table of content: SARA JEAN ENYART PA-C (NPI 1528363827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528363827 NPI number — SARA JEAN ENYART PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENYART
Provider First Name:
SARA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
UPDIKE
Provider Other First Name:
SARA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528363827
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10512 N 110TH EAST AVE
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
OWASSO
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74055-6638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-376-8410
Provider Business Mailing Address Fax Number:
918-376-8839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10512 N 110TH EAST AVE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
OWASSO
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74055-6638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-376-8149
Provider Business Practice Location Address Fax Number:
918-376-8410
Provider Enumeration Date:
01/18/2011

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: 363A00000X , with the licence number:  1993 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200319280A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com