Provider Demographics
NPI:1104920461
Name:FILL, SARA G (PA-C)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:G
Last Name:FILL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8055 O ST
Mailing Address - Street 2:STE 300
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2580
Mailing Address - Country:US
Mailing Address - Phone:402-421-0896
Mailing Address - Fax:402-421-0945
Practice Address - Street 1:2116 W FAIDLEY AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4645
Practice Address - Country:US
Practice Address - Phone:308-398-5560
Practice Address - Fax:308-398-5306
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE1006363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE244457OtherMIDLANDS CHOICE CCH
NE278972OtherCOVENTRY CCH
NE38734OtherBCBS NE CCH
P44885Medicare UPIN
NE244457OtherMIDLANDS CHOICE CCH