Provider Demographics
NPI:1861707374
Name:STUIT, SANDRA MAE (NP-C)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:MAE
Last Name:STUIT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2731 DURHAM AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-3853
Mailing Address - Country:US
Mailing Address - Phone:616-363-7805
Mailing Address - Fax:
Practice Address - Street 1:10 CADILLAC DRIVE STE 350
Practice Address - Street 2:TWO CREEKSIDE CROSSING
Practice Address - City:BREENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:888-584-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704160473363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily