Provider Demographics
NPI:1679857502
Name:NEVIL, SARA J (NP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:J
Last Name:NEVIL
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:J
Other - Last Name:BANTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:IN
Mailing Address - Zip Code:46991-0117
Mailing Address - Country:US
Mailing Address - Phone:765-603-3915
Mailing Address - Fax:
Practice Address - Street 1:119 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-3805
Practice Address - Country:US
Practice Address - Phone:765-662-7289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003707A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201057050Medicaid
INM400059750Medicare PIN