Healthcare Provider Details

I. General information

NPI: 1376843656
Provider Name (Legal Business Name): SARA DADE EWERT PNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE S
BIRMINGHAM AL
35233-1711
US

IV. Provider business mailing address

1600 7TH AVE S
BIRMINGHAM AL
35233-1711
US

V. Phone/Fax

Practice location:
  • Phone: 56-386-9942
  • Fax:
Mailing address:
  • Phone: 859-462-0009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1-164391
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number1514
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: