Individual
MRS. SARA OPENSHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4430 MISSOURI AVE, FORT LEONARD WOOD, MO 65473-9098
(573) 596-1765
Mailing address
4430 MISSOURI AVE, FORT LEONARD WOOD, MO 65473-9098
(573) 596-1765
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2015034707
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000012169
MEDICARE - GROUP (MOB)
MO
01
—
1265754501
MEDICAID - GROUP
MO
01
—
26D0889777
CLIA (MOB)
MO
01
—
26D2006074
CLIA
MO
01
—
509319209
MEDICAID - GROUP (MOB)
MO
01
—
MA2517
MEDICARE - GROUP
MO
Enumeration date
09/30/2015
Last updated
08/10/2022
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