Healthcare Provider Details

I. General information

NPI: 1497465017
Provider Name (Legal Business Name): SARA ALEM KEFETEW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 12/05/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7416 TARMAC WAY
NASHVILLE TN
37211-0209
US

IV. Provider business mailing address

2500 CHARLOTTE AVE
NASHVILLE TN
37209-4129
US

V. Phone/Fax

Practice location:
  • Phone: 615-497-4432
  • Fax:
Mailing address:
  • Phone: 615-340-7781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number000023335
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: