Healthcare Provider Details

I. General information

NPI: 1730705724
Provider Name (Legal Business Name): SARA EMMERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 E PRESIDENT GEORGE BUSH HWY
RICHARDSON TX
75082-3542
US

IV. Provider business mailing address

7014 WALLING LN
DALLAS TX
75231-7310
US

V. Phone/Fax

Practice location:
  • Phone: 469-204-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number847458
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number1014435
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: