Healthcare Provider Details

I. General information

NPI: 1962754259
Provider Name (Legal Business Name): SARAH JANE DRAEGER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 MERCY DR STE 101
MUSKEGON MI
49444-1881
US

IV. Provider business mailing address

2067 OAKWOOD AVE NE
GRAND RAPIDS MI
49505-4169
US

V. Phone/Fax

Practice location:
  • Phone: 231-733-1912
  • Fax:
Mailing address:
  • Phone: 616-218-9569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601013166
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: