Provider Demographics
NPI:1760064307
Name:DAVIDSON, SARA E (RN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:DAVIDSON
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 1:4041 S MCCLINTOCK DR STE 302
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5879
Mailing Address - Country:US
Mailing Address - Phone:520-233-7111
Mailing Address - Fax:
Practice Address - Street 1:1430 E CAMINO CHAVINDA
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-5290
Practice Address - Country:US
Practice Address - Phone:520-678-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN174664163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health