Provider Demographics
NPI:1023384286
Name:DENAULT, SARA MARIE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:MARIE
Last Name:DENAULT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75685 DOLMAR CT
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-3305
Mailing Address - Country:US
Mailing Address - Phone:760-567-6511
Mailing Address - Fax:
Practice Address - Street 1:75685 DOLMAR CT
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-3305
Practice Address - Country:US
Practice Address - Phone:760-567-6511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-31
Last Update Date:2012-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 194292164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse