Provider Demographics
NPI:1114168911
Name:BELLUOMO, SARA BETH (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:BETH
Last Name:BELLUOMO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1509 ANNE DR
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-4537
Mailing Address - Country:US
Mailing Address - Phone:586-915-5153
Mailing Address - Fax:
Practice Address - Street 1:22101 MOROSS RD
Practice Address - Street 2:PHYSICIAN EXTENDER, ST. JOHN HOSPITAL & MEDICAL CENTER
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2148
Practice Address - Country:US
Practice Address - Phone:313-343-3134
Practice Address - Fax:313-343-7495
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIA1108249363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health