Healthcare Provider Details

I. General information

NPI: 1144789827
Provider Name (Legal Business Name): SARA JANE ASHTENEAU FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA JANE ASHTENEAU FNP-BC

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 SOUTH AVE
TOLEDO OH
43615-6417
US

IV. Provider business mailing address

29007 SUGAR ISLAND CT
GIBRALTAR MI
48173-9571
US

V. Phone/Fax

Practice location:
  • Phone: 731-394-1145
  • Fax:
Mailing address:
  • Phone: 734-318-8044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704355854
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0038602
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704355854
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703115711
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: