Provider Demographics
NPI:1699700500
Name:ABBOTT, SARA MARIE (ANP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12110 WOODWARD DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-1951
Mailing Address - Country:US
Mailing Address - Phone:907-334-2274
Mailing Address - Fax:907-269-2048
Practice Address - Street 1:3601 C ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5923
Practice Address - Country:US
Practice Address - Phone:907-334-2274
Practice Address - Fax:907-269-2048
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK24776163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP9635Medicaid
AK8EC720Medicare ID - Type Unspecified