Provider Demographics
NPI:1205333689
Name:BEAULIEU, SARAH (FNP-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 ANTLER CT
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-8942
Mailing Address - Country:US
Mailing Address - Phone:734-377-3539
Mailing Address - Fax:
Practice Address - Street 1:17177 N LAUREL PARK DR STE 131
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3952
Practice Address - Country:US
Practice Address - Phone:734-462-3210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704279898363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1205333689Medicaid