Provider Demographics
NPI:1164159463
Name:DEVINE, SARA (PA)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:DEVINE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:WY
Mailing Address - Zip Code:82331-0549
Mailing Address - Country:US
Mailing Address - Phone:307-326-3169
Mailing Address - Fax:307-326-3259
Practice Address - Street 1:1300 W BRIDGE AVE
Practice Address - Street 2:STE 102
Practice Address - City:SARATOGA
Practice Address - State:WY
Practice Address - Zip Code:82331-0549
Practice Address - Country:US
Practice Address - Phone:307-326-3090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WYPA1214363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant