Provider Demographics
NPI:1285193698
Name:WILEY, SARAH GAE (FNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:GAE
Last Name:WILEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:GAE
Other - Last Name:ELSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:333 S KALAMAZOO AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1714
Mailing Address - Country:US
Mailing Address - Phone:269-558-0080
Mailing Address - Fax:
Practice Address - Street 1:333 S KALAMAZOO AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1714
Practice Address - Country:US
Practice Address - Phone:269-558-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704284928363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily