Provider Demographics
NPI:1033515697
Name:UNDERWOOD, SARA L (FNP-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:L
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:STANKEVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7125 ORCHARD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3615
Mailing Address - Country:US
Mailing Address - Phone:248-865-7481
Mailing Address - Fax:248-865-7469
Practice Address - Street 1:11650 BELLEVILLE RD
Practice Address - Street 2:STE. 150
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-3380
Practice Address - Country:US
Practice Address - Phone:734-699-9888
Practice Address - Fax:734-293-1774
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704273774163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse