Provider Demographics
NPI:1659720456
Name:DAVIDSON, SARAH VANECIA (CNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:VANECIA
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:HEFLIN
Mailing Address - State:AL
Mailing Address - Zip Code:36264-6187
Mailing Address - Country:US
Mailing Address - Phone:256-201-3642
Mailing Address - Fax:
Practice Address - Street 1:209 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WEDOWEE
Practice Address - State:AL
Practice Address - Zip Code:36278
Practice Address - Country:US
Practice Address - Phone:256-357-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-106332363LF0000X
GARN174428363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily