Healthcare Provider Details

I. General information

NPI: 1669046504
Provider Name (Legal Business Name): SARA K MUNRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14825 SOUTHFIELD RD
ALLEN PARK MI
48101-2642
US

IV. Provider business mailing address

15750 GULLEY ST
TAYLOR MI
48180-5024
US

V. Phone/Fax

Practice location:
  • Phone: 313-383-7071
  • Fax: 313-383-7194
Mailing address:
  • Phone: 313-319-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704249129
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: