Healthcare Provider Details

I. General information

NPI: 1043134687
Provider Name (Legal Business Name): SARAH MADISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 LAKE SHORE DR
CHARLEVOIX MI
49720-1931
US

IV. Provider business mailing address

14700 LAKE SHORE DR
CHARLEVOIX MI
49720-1931
US

V. Phone/Fax

Practice location:
  • Phone: 231-547-8868
  • Fax: 231-392-7321
Mailing address:
  • Phone: 231-547-8868
  • Fax: 231-392-7321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number4704385728
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: