Provider Demographics
NPI:1891130415
Name:TIESING, SARAH W
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:W
Last Name:TIESING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15213 LAVENHAM TER
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-1903
Mailing Address - Country:US
Mailing Address - Phone:919-323-1751
Mailing Address - Fax:
Practice Address - Street 1:15213 LAVENHAM TER
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-1903
Practice Address - Country:US
Practice Address - Phone:919-323-1751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006177363LF0000X
VA0024175669363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily