Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | A162431 | IA |
NPI | 1003401720 |
---|---|
Provider Name | Sara Casey |
First Address | Spencer, IA 51301-4300 |
Second Address | Spencer, IA 51301-4300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2021 |
Last Update Date | 04/03/2021 |