Provider Demographics
NPI:1245853183
Name:HUNSICKER, SARA (PA)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:HUNSICKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3920 N UNION BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-1907
Mailing Address - Country:US
Mailing Address - Phone:719-694-3595
Mailing Address - Fax:719-493-9936
Practice Address - Street 1:3920 N UNION BLVD STE 150
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-1907
Practice Address - Country:US
Practice Address - Phone:719-694-3595
Practice Address - Fax:719-493-9936
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant