Provider Demographics
NPI:1386750347
Name:KACZMAREK, SARA (CRNA)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:KACZMAREK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-1182
Mailing Address - Country:US
Mailing Address - Phone:740-266-6622
Mailing Address - Fax:740-266-6453
Practice Address - Street 1:2718 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-1182
Practice Address - Country:US
Practice Address - Phone:740-266-6622
Practice Address - Fax:740-266-6453
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18607367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0756034Medicaid
P00395504OtherRAILROAD MEDICARE
WV0065962000Medicaid
OH0756034Medicaid