Provider Demographics
NPI:1962740266
Name:DERINGER-KOHORST, SARA ANN (PA-C)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:DERINGER-KOHORST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ANN
Other - Last Name:DERINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9900 W M 21
Mailing Address - Street 2:
Mailing Address - City:OVID
Mailing Address - State:MI
Mailing Address - Zip Code:48866-9523
Mailing Address - Country:US
Mailing Address - Phone:989-834-2243
Mailing Address - Fax:989-834-5478
Practice Address - Street 1:9900 W M 21
Practice Address - Street 2:
Practice Address - City:OVID
Practice Address - State:MI
Practice Address - Zip Code:48866-9523
Practice Address - Country:US
Practice Address - Phone:989-834-2243
Practice Address - Fax:989-834-5478
Is Sole Proprietor?:No
Enumeration Date:2013-01-21
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006331363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical