Provider Demographics
NPI:1144789827
Name:ASHTENEAU, SARA JANE (RN)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:JANE
Last Name:ASHTENEAU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:JANE
Other - Last Name:ASHTENEAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:15666 CYNTHIA ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2013
Mailing Address - Country:US
Mailing Address - Phone:734-318-8044
Mailing Address - Fax:
Practice Address - Street 1:43825 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2551
Practice Address - Country:US
Practice Address - Phone:438-254-8188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703115711164W00000X
MI4704355854163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse