Healthcare Provider Details

I. General information

NPI: 1457853095
Provider Name (Legal Business Name): SARA JEAN NURENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

IV. Provider business mailing address

2420 W CENTERLINE RD
SAINT JOHNS MI
48879-9212
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-2786
  • Fax:
Mailing address:
  • Phone: 989-224-8211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501003497
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: