Basic Information
| Provider Information | |||||||||
| NPI: | 1346838893 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAUER | ||||||||
| FirstName: | TABATHA | ||||||||
| MiddleName: | MARIE STABLER | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6810 STATE ROUTE 162 STE 215 | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620628566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183916495 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 PROFESSIONAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620625672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182887244 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2021 | ||||||||
| LastUpdateDate: | 03/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 085.008911 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.