Provider Demographics
NPI:1497465017
Name:KEFETEW, SARA ALEM
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ALEM
Last Name:KEFETEW
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 1:2500 CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4129
Mailing Address - Country:US
Mailing Address - Phone:615-340-7781
Mailing Address - Fax:
Practice Address - Street 1:7416 TARMAC WAY
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-0209
Practice Address - Country:US
Practice Address - Phone:615-497-4432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000023335163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool