Provider Demographics
NPI:1538511621
Name:STRAIT, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:STRAIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:LEIBRANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1650 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5206
Mailing Address - Country:US
Mailing Address - Phone:231-672-3155
Mailing Address - Fax:
Practice Address - Street 1:3570 HENRY ST STE 220
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-4576
Practice Address - Country:US
Practice Address - Phone:231-672-3155
Practice Address - Fax:231-672-3157
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704248332363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1538511621Medicaid