Healthcare Provider Details

I. General information

NPI: 1831889914
Provider Name (Legal Business Name): SARA ELIZABETH STOUT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 SEMINOLE RD
NORTON SHORES MI
49444-3720
US

IV. Provider business mailing address

801 ROSEHILL RD
JACKSON MI
49202-1762
US

V. Phone/Fax

Practice location:
  • Phone: 231-737-4041
  • Fax:
Mailing address:
  • Phone: 517-212-2008
  • Fax: 517-212-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704273726
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: