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NPI Code Detail

MEDICARE: SARAH BEAULIEU PMHNP-BC, FNP-C

MEDICARE: SARAH BEAULIEU PMHNP-BC, FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner4704279898MI
2363LP0808XPsychiatric/Mental Health Nurse Practitioner4704279898MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205333689
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH BEAULIEU PMHNP-BC, FNP-C
Provider Business Mailing Address
First Line : 1628 BROOKFIELD DR
Second Line :
City : ANN ARBOR
State : MI
Zip : 48103-6079
Country : US
Telephone Number : 734-377-3539
Fax Number :
Provider Business Practice Location Address
First Line : 17177 N LAUREL PARK DR STE 131
Second Line :
City : LIVONIA
State : MI
Zip : 48152-3952
Country : US
Telephone Number : 734-462-3210
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2018
Last Update Date : 03/23/2026

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