MEDICARE: SARA MARIE MISSINI CNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	0030084770	GA

General Provider Information

NPI Number	:	1871283705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA MARIE MISSINI CNA

Provider Business Mailing Address
First Line	:	616 RUSSETWOOD LN
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-6407
Country	:	US
Telephone Number	:	678-508-0132
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 RUSSETWOOD LN
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-6407
Country	:	US
Telephone Number	:	678-508-0132
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2023
Last Update Date	:	05/12/2023

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