Provider Demographics
NPI:1124491501
Name:STETSON, SARA ATHEA (ANP)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ATHEA
Last Name:STETSON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:ATHEA
Other - Last Name:CHISM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9500 INDEPENDENCE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-4686
Mailing Address - Country:US
Mailing Address - Phone:907-339-7272
Mailing Address - Fax:907-339-7273
Practice Address - Street 1:11260 OLD SEWARD HWY STE 107
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3098
Practice Address - Country:US
Practice Address - Phone:907-433-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily