Provider Demographics
NPI:1194062810
Name:SLADE, SARAH JANE (FNP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JANE
Last Name:SLADE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S DOBSON RD STE A1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5694
Mailing Address - Country:US
Mailing Address - Phone:480-786-6655
Mailing Address - Fax:480-786-6996
Practice Address - Street 1:600 S DOBSON RD STE A1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5694
Practice Address - Country:US
Practice Address - Phone:480-786-6655
Practice Address - Fax:480-786-6996
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP4681OtherNURSE LICENSE