Provider Demographics
NPI:1285783969
Name:ANDERSON, SARAH L (PA)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 S 144TH ST STE 212
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5253
Mailing Address - Country:US
Mailing Address - Phone:402-637-0800
Mailing Address - Fax:402-637-0808
Practice Address - Street 1:2725 S 144TH ST STE 212
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5253
Practice Address - Country:US
Practice Address - Phone:402-637-0800
Practice Address - Fax:402-637-0808
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079554363A00000X
WI2644-023363A00000X
NE1298363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE39009OtherBCBS OF NEBRASKA
WI1285783969Medicaid
NE970025687OtherMEDICARE RAILROAD
WI680860870Medicare PIN
NE39009OtherBCBS OF NEBRASKA
Q75771Medicare UPIN
WI602550098Medicare PIN
NE970025687OtherMEDICARE RAILROAD
WI736012111Medicare PIN