Basic Information
Provider Information
NPI: 1083007942
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ELLER
FirstName: SARAH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8717 W 110TH ST STE 600
Address2:  
City: OVERLAND PARK
State: KS
PostalCode: 662102126
CountryCode: US
TelephoneNumber: 9134282900
FaxNumber: 9134282951
Practice Location
Address1: 10500 QUIVIRA RD
Address2:  
City: OVERLAND PARK
State: KS
PostalCode: 662152373
CountryCode: US
TelephoneNumber: 9135415000
FaxNumber: 9134282951
Other Information
ProviderEnumerationDate: 03/16/2015
LastUpdateDate: 08/24/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/24/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X2008007618MON Nursing Service ProvidersRegistered Nurse 
367500000XCRNA1125AZN Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 
367500000X43-557811KSY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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