Individual
SARA C HERSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
3909 NEW VISION DR, FORT WAYNE, IN 46845-1725
(260) 469-6610
(260) 969-3065
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02003108A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
021274
KAISER COMMERCIAL NUMBER
CO
05
—
200832180
—
IN
05
—
26176564
—
CO
Enumeration date
10/24/2006
Last updated
10/17/2022
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