Provider Demographics
NPI:1316948615
Name:HALTER, SARAH ANNE (CNM, FNP)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:ANNE
Last Name:HALTER
Suffix:
Gender:F
Credentials:CNM, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3348 COLUMBIA WOODS DR APT D
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-5753
Mailing Address - Country:US
Mailing Address - Phone:337-396-2809
Mailing Address - Fax:
Practice Address - Street 1:77 EAST MIDLOTHIAN BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44507-2021
Practice Address - Country:US
Practice Address - Phone:330-788-2487
Practice Address - Fax:330-788-8620
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704162932363LF0000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4631840Medicaid
MI4631840Medicaid