Healthcare Provider Details

I. General information

NPI: 1104186345
Provider Name (Legal Business Name): SARA SPRINGER ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA KHURAIBET

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 JORDAN MARIE LN
OLD MONROE MO
63369-2146
US

IV. Provider business mailing address

70 JUNGERMANN CIR STE 302
SAINT PETERS MO
63376-1637
US

V. Phone/Fax

Practice location:
  • Phone: 636-720-0310
  • Fax: 636-720-0311
Mailing address:
  • Phone: 636-706-5114
  • Fax: 636-720-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2005024558
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2012009896
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: