Provider Demographics
NPI:1063152395
Name:EMANUEL, SARA ANGELA (RN)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ANGELA
Last Name:EMANUEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 WALDEN FOREST RD
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-1563
Mailing Address - Country:US
Mailing Address - Phone:423-260-1132
Mailing Address - Fax:
Practice Address - Street 1:1404 WALDEN FOREST RD
Practice Address - Street 2:
Practice Address - City:SIGNAL MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37377-1563
Practice Address - Country:US
Practice Address - Phone:423-260-1132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN129318163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice