Provider Demographics
NPI:1962840165
Name:NYBERG, SARA LINDSEY (MMS PA-C)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LINDSEY
Last Name:NYBERG
Suffix:
Gender:F
Credentials:MMS PA-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:LINDSEY
Other - Last Name:STRUVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 S NEW BALLAS RD STE 510
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8726
Mailing Address - Country:US
Mailing Address - Phone:314-251-6710
Mailing Address - Fax:
Practice Address - Street 1:701 S NEW BALLAS RD STE 510
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8726
Practice Address - Country:US
Practice Address - Phone:314-251-6710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6614363A00000X
MO2025012348363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3031221OtherCIGNA
WI1962840165Medicaid
WI011820010Medicare PIN