Provider Demographics
NPI:1962091652
Name:GLOVER, SARAH ALYSE (ARNP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ALYSE
Last Name:GLOVER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ALYSE
Other - Last Name:KREBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1003 WALLACE WAY
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98930-8805
Mailing Address - Country:US
Mailing Address - Phone:509-203-1080
Mailing Address - Fax:
Practice Address - Street 1:1003 WALLACE WAY
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:WA
Practice Address - Zip Code:98930-8805
Practice Address - Country:US
Practice Address - Phone:509-203-1080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-16
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61134190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily