Provider Demographics
NPI:1366991820
Name:STEVENS, SARAH ROSE (FNPC)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:ROSE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ROSE
Other - Last Name:TEEGARDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNPC
Mailing Address - Street 1:4466 HERITAGE CT SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2383
Mailing Address - Country:US
Mailing Address - Phone:616-301-0808
Mailing Address - Fax:616-301-7887
Practice Address - Street 1:4466 HERITAGE CT SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2383
Practice Address - Country:US
Practice Address - Phone:616-301-0808
Practice Address - Fax:616-301-7887
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019932363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0193046Medicaid