Provider Demographics
NPI:1699949057
Name:STAKER, SARA J (APRN, C-FNP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:J
Last Name:STAKER
Suffix:
Gender:F
Credentials:APRN, C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 W 100 N # 42
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:UT
Mailing Address - Zip Code:84647-1343
Mailing Address - Country:US
Mailing Address - Phone:435-462-3652
Mailing Address - Fax:
Practice Address - Street 1:245 W 100 N # 42
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:UT
Practice Address - Zip Code:84647-1343
Practice Address - Country:US
Practice Address - Phone:435-462-3652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2046634405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily