Provider Demographics
NPI:1245619170
Name:BADGER, SARA HILDA (LM, CPM)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:HILDA
Last Name:BADGER
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:BADGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LM, CPM
Mailing Address - Street 1:802 MERRITT ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3398
Mailing Address - Country:US
Mailing Address - Phone:559-907-5341
Mailing Address - Fax:
Practice Address - Street 1:802 MERRITT ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-3398
Practice Address - Country:US
Practice Address - Phone:559-907-5341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI16040010176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI47-1756922OtherEIN