Provider Demographics
NPI:1578239455
Name:DEHARTY, SARA (RN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:DEHARTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7559 E OSAGE AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-9767
Mailing Address - Country:US
Mailing Address - Phone:480-209-3690
Mailing Address - Fax:
Practice Address - Street 1:7559 E OSAGE AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-9767
Practice Address - Country:US
Practice Address - Phone:480-209-3690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN163430163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant