Provider Demographics
NPI:1841253820
Name:PAUL, SARA C (NP)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:C
Last Name:PAUL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 GRAYSTONE PL SE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-8201
Mailing Address - Country:US
Mailing Address - Phone:828-326-2354
Mailing Address - Fax:828-326-2385
Practice Address - Street 1:3521 GRAYSTONE PL SE
Practice Address - Street 2:SUITE 202
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-8201
Practice Address - Country:US
Practice Address - Phone:828-326-2354
Practice Address - Fax:828-326-2385
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC112389363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP76384Medicare UPIN
NC2807603Medicare PIN