Provider Demographics
NPI:1962283424
Name:LUSTED, SARAH BELL (NP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:BELL
Last Name:LUSTED
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ANN
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 GRADY JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-6026
Mailing Address - Country:US
Mailing Address - Phone:912-489-6246
Mailing Address - Fax:912-489-6346
Practice Address - Street 1:5 GRADY JOHNSON RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-6026
Practice Address - Country:US
Practice Address - Phone:912-489-6246
Practice Address - Fax:912-489-6346
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN231865363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care