Provider Demographics
NPI:1316172208
Name:MAYER, SARAH ELLEN (APRN)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ELLEN
Last Name:MAYER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:ELLEN
Other - Last Name:BROUGHTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:232 S WOODS MILL RD
Mailing Address - Street 2:STE 400
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3417
Mailing Address - Country:US
Mailing Address - Phone:314-205-6149
Mailing Address - Fax:314-576-2350
Practice Address - Street 1:232 S WOODS MILL RD
Practice Address - Street 2:STE 400
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3417
Practice Address - Country:US
Practice Address - Phone:314-205-6149
Practice Address - Fax:314-576-2350
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007021402363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00723183OtherRR MEDICARE
MO151850002Medicare PIN