Healthcare Provider Details

I. General information

NPI: 1033669346
Provider Name (Legal Business Name): GOLNAZ SADR CNS, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 10/09/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 RESEARCH BLVD STE LL2
AUSTIN TX
78759-5200
US

IV. Provider business mailing address

11111 RESEARCH BLVD STE LL2
AUSTIN TX
78759-5200
US

V. Phone/Fax

Practice location:
  • Phone: 512-518-4673
  • Fax: 512-334-2702
Mailing address:
  • Phone: 512-518-4673
  • Fax: 512-334-2702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberAP131518
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: