Provider Demographics
NPI:1174617310
Name:HAKE, SARA JANE (CNM, DNP)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:JANE
Last Name:HAKE
Suffix:
Gender:F
Credentials:CNM, DNP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:JANE
Other - Last Name:HAKE BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, DNP
Mailing Address - Street 1:2021 EAST CANDLE SPRUCE COVE
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092
Mailing Address - Country:US
Mailing Address - Phone:801-943-3823
Mailing Address - Fax:
Practice Address - Street 1:50 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-587-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5158182-4402367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD5232Medicaid
UTD5232Medicaid
UT005703713Medicare ID - Type Unspecified