Healthcare Provider Details

I. General information

NPI: 1154832301
Provider Name (Legal Business Name): SARAH RUTH DAMICK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 NAOMI ST
PLAINWELL MI
49080-1257
US

IV. Provider business mailing address

1717 SHAFFER ST STE 2
KALAMAZOO MI
49048-1623
US

V. Phone/Fax

Practice location:
  • Phone: 269-552-0100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704242697
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: