Provider Demographics
NPI:1962075788
Name:MAESTAS, SARA RHIANNON (MSN, APRN, NP-C)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:RHIANNON
Last Name:MAESTAS
Suffix:
Gender:F
Credentials:MSN, APRN, NP-C
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:15498 S MIDNIGHT VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:BLUFFDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84065-1759
Mailing Address - Country:US
Mailing Address - Phone:801-656-9737
Mailing Address - Fax:
Practice Address - Street 1:6360 S 3000 E STE 210
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6972
Practice Address - Country:US
Practice Address - Phone:385-220-9009
Practice Address - Fax:801-869-1987
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9254785-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner