Healthcare Provider Details

I. General information

NPI: 1992030274
Provider Name (Legal Business Name): SARA ANN HLAD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 E FRANKLIN ST
LINCOLN KS
67455-1751
US

IV. Provider business mailing address

PO BOX 467
LINCOLN KS
67455-0467
US

V. Phone/Fax

Practice location:
  • Phone: 785-524-4474
  • Fax: 785-524-5320
Mailing address:
  • Phone: 785-524-4474
  • Fax: 785-524-5320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1501346
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: