Basic Information
Provider Information | |||||||||
NPI: | 1467740084 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HINKLEY | ||||||||
FirstName: | SARA | ||||||||
MiddleName: | JANE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | LUTZ | ||||||||
OtherFirstName: | SARA | ||||||||
OtherMiddleName: | JANE | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | D.O. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 22067 | ||||||||
Address2: |   | ||||||||
City: | LANSING | ||||||||
State: | MI | ||||||||
PostalCode: | 489098016 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6169751845 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 205 N EAST AVE | ||||||||
Address2: |   | ||||||||
City: | JACKSON | ||||||||
State: | MI | ||||||||
PostalCode: | 492011753 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5177884800 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/17/2011 | ||||||||
LastUpdateDate: | 08/21/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 5315049490 | MI | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
No ID Information.