Healthcare Provider Details

I. General information

NPI: 1538434162
Provider Name (Legal Business Name): SARAH J OSTROM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4175 S ALAMO AVE
DAVIS MONTHAN AFB AZ
85707-4402
US

IV. Provider business mailing address

4175 S ALAMO AVE
DAVIS MONTHAN AFB AZ
85707-4402
US

V. Phone/Fax

Practice location:
  • Phone: 520-228-2614
  • Fax:
Mailing address:
  • Phone: 520-228-2614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA12029
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2443
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: