Healthcare Provider Details

I. General information

NPI: 1932749249
Provider Name (Legal Business Name): SARA VIRGINIA SNIFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 CIRCLE DR
TRAVERSE CITY MI
49684-2700
US

IV. Provider business mailing address

876 BOON ST
TRAVERSE CITY MI
49686-4303
US

V. Phone/Fax

Practice location:
  • Phone: 231-932-4912
  • Fax: 231-935-0613
Mailing address:
  • Phone: 231-633-3975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06190134
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: