Healthcare Provider Details

I. General information

NPI: 1336529247
Provider Name (Legal Business Name): SARA M SHOLAR D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 POLE CREEK XING
SIDNEY NE
69162
US

IV. Provider business mailing address

1000 POLE CREEK XING
SIDNEY NE
69162-2901
US

V. Phone/Fax

Practice location:
  • Phone: 308-254-5825
  • Fax:
Mailing address:
  • Phone: 308-254-5825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberUO 4615
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS14547
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1998
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: