Healthcare Provider Details

I. General information

NPI: 1295129633
Provider Name (Legal Business Name): SARAH LYNN SPENCER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 HIDDEN MEADOWS DR STE 220
HILLSDALE MI
49242-9812
US

IV. Provider business mailing address

451 HIDDEN MEADOWS DR STE 220
HILLSDALE MI
49242-9812
US

V. Phone/Fax

Practice location:
  • Phone: 571-437-8292
  • Fax:
Mailing address:
  • Phone: 517-437-8292
  • Fax: 517-437-8295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101021761
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: