Basic Information
| Provider Information | |||||||||
| NPI: | 1265979058 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SACDALAN | ||||||||
| FirstName: | SUE | ||||||||
| MiddleName: | YARNG | ||||||||
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| Credential: | MSN, RN, NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9044 OAKRIDGE TRL | ||||||||
| Address2: | |||||||||
| City: | SHELBY TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483171824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488915812 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1375 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LAPEER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484461350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106675500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2017 | ||||||||
| LastUpdateDate: | 01/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 4704216287 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.