=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336798339
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARA L. JOOST CFNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2019
-----------------------------------------------------
Last Update Date | 02/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30795 23 MILE RD. SUITE 202
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-421-1740
-----------------------------------------------------
Fax | 586-421-1744
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30795 23 MILE RD. SUITE 202
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-421-1740
-----------------------------------------------------
Fax | 586-421-1744
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 4704304288
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------