Provider Demographics
NPI:1134826340
Name:MUNDAY, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MUNDAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3446 STREET DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2704
Mailing Address - Country:US
Mailing Address - Phone:423-329-1352
Mailing Address - Fax:
Practice Address - Street 1:1135 VOLUNTEER PKWY STE 5
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-4658
Practice Address - Country:US
Practice Address - Phone:423-968-4353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32403363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily