Provider Demographics
NPI:1902100142
Name:REMILLARD, SARA A (CRNA)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:A
Last Name:REMILLARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:SARA
Other - Middle Name:A
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-0725
Mailing Address - Country:US
Mailing Address - Phone:607-547-3153
Mailing Address - Fax:607-547-6539
Practice Address - Street 1:1 ATWELL RD
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1301
Practice Address - Country:US
Practice Address - Phone:607-547-3153
Practice Address - Fax:607-547-6539
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY542991367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered