Basic Information
| Provider Information | |||||||||
| NPI: | 1508354770 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STREETY | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | DENIECE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5060 GOLD LEAF LN | ||||||||
| Address2: | |||||||||
| City: | PINSON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351262889 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058370730 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7054 VETERANS PKWY | ||||||||
| Address2: | |||||||||
| City: | PELL CITY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351255117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052277985 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2018 | ||||||||
| LastUpdateDate: | 04/24/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 1-074532 | AL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LG0600X | 1-074532 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.