Healthcare Provider Details

I. General information

NPI: 1750102679
Provider Name (Legal Business Name): SARAH ELIZABETH BUHL AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2147 E BLACKMORE RD
MAYVILLE MI
48744-9730
US

IV. Provider business mailing address

2147 E BLACKMORE RD
MAYVILLE MI
48744-9730
US

V. Phone/Fax

Practice location:
  • Phone: 989-525-3422
  • Fax:
Mailing address:
  • Phone: 989-525-3422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704285019
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: