Provider Demographics
NPI:1235680364
Name:FAWSON, SARA (DNP CNM WHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:FAWSON
Suffix:
Gender:F
Credentials:DNP CNM WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W KIRKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6821
Mailing Address - Country:US
Mailing Address - Phone:801-695-1318
Mailing Address - Fax:
Practice Address - Street 1:226 ASHVILLE AVE
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6660
Practice Address - Country:US
Practice Address - Phone:919-852-1053
Practice Address - Fax:919-233-9012
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT320368-8900363LW0102X
NC682367A00000X
UT320368-4402367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health