Provider Demographics
NPI:1376973602
Name:RAO, SARITA (ANP-BC)
Entity Type:Individual
Prefix:
First Name:SARITA
Middle Name:
Last Name:RAO
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22060 BEECH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2853
Mailing Address - Country:US
Mailing Address - Phone:313-228-0505
Mailing Address - Fax:313-228-0506
Practice Address - Street 1:44270 DUCHESS DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3242
Practice Address - Country:US
Practice Address - Phone:734-658-7706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704276220363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health