Basic Information
| Provider Information | |||||||||
| NPI: | 1033515697 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | UNDERWOOD | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | FNP-C | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | STANKEVICH | ||||||||
| OtherFirstName: | SARA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7125 ORCHARD LAKE RD | ||||||||
| Address2: | |||||||||
| City: | WEST BLOOMFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483223615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488657481 | ||||||||
| FaxNumber: | 2488657469 | ||||||||
| Practice Location | |||||||||
| Address1: | 11650 BELLEVILLE RD | ||||||||
| Address2: | STE. 150 | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481113380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346999888 | ||||||||
| FaxNumber: | 7342931774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2014 | ||||||||
| LastUpdateDate: | 07/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 4704273774 | MI | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 4704273774 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.