Provider Demographics
NPI:1871283705
Name:MISSINI, SARA MARIE (CNA)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:MISSINI
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 RUSSETWOOD LN
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-6407
Mailing Address - Country:US
Mailing Address - Phone:678-508-0132
Mailing Address - Fax:
Practice Address - Street 1:616 RUSSETWOOD LN
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-6407
Practice Address - Country:US
Practice Address - Phone:678-508-0132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0030084770376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty