Healthcare Provider Details

I. General information

NPI: 1932158029
Provider Name (Legal Business Name): SARAH J WILLEY ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 M 119 STE C
HARBOR SPRINGS MI
49740-9373
US

IV. Provider business mailing address

3434 M 119 STE C
HARBOR SPRINGS MI
49740-9373
US

V. Phone/Fax

Practice location:
  • Phone: 231-348-9900
  • Fax:
Mailing address:
  • Phone: 231-348-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704101925
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: