Provider Demographics
NPI:1699249789
Name:BOTELLO, SARA MICHELE (RN, NNP-BC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MICHELE
Last Name:BOTELLO
Suffix:
Gender:F
Credentials:RN, NNP-BC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:MICHELE
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5430 FREDERICKSBURG RD STE 508
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3561
Mailing Address - Country:US
Mailing Address - Phone:210-541-8281
Mailing Address - Fax:210-541-9123
Practice Address - Street 1:5430 FREDERICKSBURG RD STE 508
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3561
Practice Address - Country:US
Practice Address - Phone:210-541-8281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX717662363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal