MEDICARE: SARAH KAY DEPAS PNP

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
1	363LA2100X	Acute Care Nurse Practitioner	4704211846	MI

General Provider Information

NPI Number	:	1518020395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH KAY DEPAS PNP

Provider Business Mailing Address
First Line	:	100 MICHIGAN ST NE
Second Line	:	MC 845
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2560
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 MICHIGAN ST NE STE 3003
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2528
Country	:	US
Telephone Number	:	616-267-2009
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	08/04/2022

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