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General NPI Number Information
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NPI Number | 1417371485
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Entity Type | Individual
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Provider Name | SARA E MCKINZIE WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 1275 HAWTHORN RD
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City | SALEM
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State | IL
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Zip | 62881-1028
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Country | US
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Telephone | 618-548-4545
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Fax | 618-548-4577
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Provider Business Mailing Address
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Address Line | 9447 HOLY CROSS LN
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City | BREESE
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State | IL
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Zip | 62230-3510
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Country | US
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Telephone | 618-526-2209
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Fax | 618-526-7372
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209011044
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 209011044
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License Number State | IL
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