Basic Information
Provider Information
NPI: 1538828694
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HINMAN
FirstName: SARA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8087 IRIS CT
Address2:  
City: ARVADA
State: CO
PostalCode: 800052138
CountryCode: US
TelephoneNumber: 3038037411
FaxNumber:  
Practice Location
Address1: 27B TALISMAN DR UNIT 3
Address2:  
City: PAGOSA SPRINGS
State: CO
PostalCode: 811477914
CountryCode: US
TelephoneNumber: 9703720456
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/15/2021
LastUpdateDate: 12/15/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/15/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPN.0997193-NPCOY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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