Provider Demographics
NPI:1639050743
Name:AMOS, SARA ELISE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ELISE
Last Name:AMOS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2838 JENNIFER LN
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB
Mailing Address - State:MO
Mailing Address - Zip Code:64506-1015
Mailing Address - Country:US
Mailing Address - Phone:816-255-7211
Mailing Address - Fax:
Practice Address - Street 1:2838 JENNIFER LN
Practice Address - Street 2:
Practice Address - City:COUNTRY CLUB
Practice Address - State:MO
Practice Address - Zip Code:64506-1015
Practice Address - Country:US
Practice Address - Phone:816-255-7211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013005714163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty