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Individual
SARAH NULL
Active
Individual
SARAH NULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
TEMORARY
TX
363A00000X
Physician Assistant
Primary
PA06852
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA06852
LICENSE
TX
Enumeration date
08/24/2010
Last updated
01/10/2019
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