MEDICARE: SARA L OWEN ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	A101649	IA
2	363LF0000X	Family Nurse Practitioner	A101649	IA

General Provider Information

NPI Number	:	1922511492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA L OWEN ARNP

Provider Business Mailing Address
First Line	:	5820 WINWOOD DR
Second Line	:
City	:	JOHNSTON
State	:	IA
Zip	:	50131-1821
Country	:	US
Telephone Number	:	515-643-6150
Fax Number	:	515-643-6149

Provider Business Practice Location Address
First Line	:	5820 WINWOOD DR
Second Line	:
City	:	JOHNSTON
State	:	IA
Zip	:	50131-1821
Country	:	US
Telephone Number	:	515-643-6150
Fax Number	:	515-643-6149

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2017
Last Update Date	:	06/16/2018

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