Healthcare Provider Details

I. General information

NPI: 1508780289
Provider Name (Legal Business Name): SARA JEAN NANKERVIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 CORYDON DR
MOUNT MORRIS MI
48458-1601
US

IV. Provider business mailing address

1025 CORYDON DR
MOUNT MORRIS MI
48458-1601
US

V. Phone/Fax

Practice location:
  • Phone: 248-558-0029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704409710
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: