Healthcare Provider Details

I. General information

NPI: 1124063300
Provider Name (Legal Business Name): SARA WALLENIUS MERTZ A/GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 OVERLOOK RD
ASHEVILLE NC
28803-3317
US

IV. Provider business mailing address

501 BILTMORE AVE STE G276.10
ASHEVILLE NC
28801-4601
US

V. Phone/Fax

Practice location:
  • Phone: 828-213-8442
  • Fax:
Mailing address:
  • Phone: 828-213-4502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5005118
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number200950150NP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number99007553N4
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: