Provider Demographics
NPI:1861859316
Name:STEPHENS, SARA E
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:E
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 BIDDLE AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-2954
Mailing Address - Country:US
Mailing Address - Phone:734-686-2438
Mailing Address - Fax:
Practice Address - Street 1:822 BIDDLE AVE APT 7
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-2954
Practice Address - Country:US
Practice Address - Phone:734-686-2438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other