Provider Demographics
NPI:1518361336
Name:DAVIS, SAGE M (NP-C)
Entity Type:Individual
Prefix:
First Name:SAGE
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SAGE
Other - Middle Name:M
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:559 W GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48216-2200
Mailing Address - Country:US
Mailing Address - Phone:313-554-0485
Mailing Address - Fax:313-228-0283
Practice Address - Street 1:5716 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210-3039
Practice Address - Country:US
Practice Address - Phone:313-554-1095
Practice Address - Fax:313-899-3560
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704292364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily