Healthcare Provider Details

I. General information

NPI: 1780545673
Provider Name (Legal Business Name): SARA WATHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15882 BEAR CREEK RD
EARLHAM IA
50072-5593
US

IV. Provider business mailing address

15882 BEAR CREEK RD
EARLHAM IA
50072-5593
US

V. Phone/Fax

Practice location:
  • Phone: 312-388-5527
  • Fax: 312-388-5527
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: