Healthcare Provider Details

I. General information

NPI: 1265426985
Provider Name (Legal Business Name): SARAH C STEVENS RN OPAC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 N JACKSON ST STE 930
TULLAHOMA TN
37388-2200
US

IV. Provider business mailing address

1905 N JACKSON ST STE 930
TULLAHOMA TN
37388-2200
US

V. Phone/Fax

Practice location:
  • Phone: 931-455-8676
  • Fax: 931-455-9983
Mailing address:
  • Phone: 931-455-8676
  • Fax: 931-455-9983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberOPA687
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: