Provider Demographics
NPI:1821810722
Name:BOZARTH, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BOZARTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:NEWSOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3015 NE 52ND CT
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50317-4915
Mailing Address - Country:US
Mailing Address - Phone:515-650-0898
Mailing Address - Fax:
Practice Address - Street 1:6120 NE 12TH AVE APT 102
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-8802
Practice Address - Country:US
Practice Address - Phone:515-720-6455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAX000913411253Z00000X
347C00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAX000913411Medicaid