Healthcare Provider Details

I. General information

NPI: 1992669790
Provider Name (Legal Business Name): SARA MARTIA WAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8088 VINEYARD PKWY
KALAMAZOO MI
49009-3892
US

IV. Provider business mailing address

8088 VINEYARD PKWY
KALAMAZOO MI
49009-3892
US

V. Phone/Fax

Practice location:
  • Phone: 269-286-7160
  • Fax:
Mailing address:
  • Phone: 269-286-7160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number4704297640
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: