Provider Demographics
NPI:1215539358
Name:SARATAN, MARIAH CLAIRE DOMER
Entity Type:Individual
Prefix:
First Name:MARIAH CLAIRE
Middle Name:DOMER
Last Name:SARATAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 RIVER LODGE TRL S APT 439
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-0832
Mailing Address - Country:US
Mailing Address - Phone:408-329-8650
Mailing Address - Fax:
Practice Address - Street 1:3250 RIVER LODGE TRL S APT 439
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-0832
Practice Address - Country:US
Practice Address - Phone:408-329-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX926648163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse