Healthcare Provider Details

I. General information

NPI: 1669643284
Provider Name (Legal Business Name): SARA A BARRETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45964 BRENTWOOD ST
MACOMB MI
48042-5410
US

IV. Provider business mailing address

45964 BRENTWOOD ST
MACOMB MI
48042-5410
US

V. Phone/Fax

Practice location:
  • Phone: 616-301-8000
  • Fax: 248-338-7513
Mailing address:
  • Phone: 616-301-8000
  • Fax: 248-338-7513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704106518
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: