Basic Information
Provider Information | |||||||||
NPI: | 1558795252 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WOLFE | ||||||||
FirstName: | SARA | ||||||||
MiddleName: | LYNN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | ARNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BERDING | ||||||||
OtherFirstName: | SARA | ||||||||
OtherMiddleName: | LYNN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | ARNP | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 621 S ILLINOIS AVE | ||||||||
Address2: | SUITE 103 | ||||||||
City: | MASON CITY | ||||||||
State: | IA | ||||||||
PostalCode: | 504015489 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6414283041 | ||||||||
FaxNumber: | 6414283059 | ||||||||
Practice Location | |||||||||
Address1: | 520 S PIERCE AVE STE 150 | ||||||||
Address2: |   | ||||||||
City: | MASON CITY | ||||||||
State: | IA | ||||||||
PostalCode: | 504012711 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6414945000 | ||||||||
FaxNumber: | 6414945028 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/29/2013 | ||||||||
LastUpdateDate: | 08/04/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/04/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | H109065 | IA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   |
No ID Information.