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General NPI Number Information
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NPI Number | 1831889914
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Entity Type | Individual
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Provider Name | SARA ELIZABETH STOUT FNP
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Gender | Female
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Dates
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Enumeration Date | 05/11/2023
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 560 SEMINOLE RD
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City | NORTON SHORES
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State | MI
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Zip | 49444-3720
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Country | US
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Telephone | 231-737-4041
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Fax |
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Provider Business Mailing Address
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Address Line | 801 ROSEHILL RD
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City | JACKSON
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State | MI
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Zip | 49202-1762
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Country | US
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Telephone | 517-212-2008
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Fax | 517-212-2009
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704273726
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License Number State | MI
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