Provider Demographics
NPI:1790245512
Name:TODD, SARA MARIE (LVN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:TODD
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 PLEASANT VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78227-4553
Mailing Address - Country:US
Mailing Address - Phone:210-769-3794
Mailing Address - Fax:
Practice Address - Street 1:8411 MINERS PT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78252-2801
Practice Address - Country:US
Practice Address - Phone:210-255-1466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX330777164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse