Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 0992793 | CO |
Y | 363LA2100X | Nurse Practitioner - Acute Care | APN.0992793-NP | CO |
N | 363LG0600X | Nurse Practitioner - Gerontology | 0992793 | CO |
NPI | 1053859421 |
---|---|
Provider Name | Sarah Kate Roark |
First Address | Loveland, CO 80537-0702 |
Second Address | Pueblo, CO 81003-3320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2017 |
Last Update Date | 07/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0992793 | STATE NP LICENSE (01) | CO |