Provider Demographics
NPI:1154504470
Name:MAIVILLE, SARA DEAN (APRN-BC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:DEAN
Last Name:MAIVILLE
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 MALLORY LN
Mailing Address - Street 2:SUITE 302
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8233
Mailing Address - Country:US
Mailing Address - Phone:615-771-9958
Mailing Address - Fax:
Practice Address - Street 1:2001 MALLORY LN
Practice Address - Street 2:SUITE 302
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8233
Practice Address - Country:US
Practice Address - Phone:615-771-9958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13087363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health