=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518711670
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANG-EN SARAH LIN FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2024
-----------------------------------------------------
Last Update Date | 04/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11650 BELLEVILLE RD STE 101
-----------------------------------------------------
City | VAN BUREN TOWNSHIP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48111-3382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-481-6708
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11650 BELLEVILLE RD STE 101
-----------------------------------------------------
City | VAN BUREN TOWNSHIP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48111-3382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-481-6708
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | AP61534914
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | 4704415145
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------