Healthcare Provider Details

I. General information

NPI: 1376973602
Provider Name (Legal Business Name): SARITA RAO ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44270 DUCHESS DR
CANTON MI
48187-3242
US

IV. Provider business mailing address

22060 BEECH ST STE 200
DEARBORN MI
48124-2853
US

V. Phone/Fax

Practice location:
  • Phone: 734-658-7706
  • Fax:
Mailing address:
  • Phone: 313-228-0505
  • Fax: 313-228-0506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704276220
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: