Provider Demographics
NPI:1023679172
Name:FLORENCE, SARAH KRISTIN CRUDDEN
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KRISTIN CRUDDEN
Last Name:FLORENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N 4TH AVE E STE 200
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3179
Mailing Address - Country:US
Mailing Address - Phone:641-792-2112
Mailing Address - Fax:
Practice Address - Street 1:300 N 4TH AVE E STE 200
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3179
Practice Address - Country:US
Practice Address - Phone:641-792-2112
Practice Address - Fax:641-792-8484
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-10068207Q00000X
IADO-06179207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IADO-06179OtherSTATE LICENSE