Provider Demographics
NPI:1619681988
Name:SARTOR, ETHAN TAYLOR (BSN, RN)
Entity Type:Individual
Prefix:MR
First Name:ETHAN
Middle Name:TAYLOR
Last Name:SARTOR
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-8136
Mailing Address - Country:US
Mailing Address - Phone:216-596-2800
Mailing Address - Fax:
Practice Address - Street 1:5151 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-8136
Practice Address - Country:US
Practice Address - Phone:216-596-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1026801163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1026801OtherTEXAS BOARD OF NURSING