Provider Demographics
NPI:1588025241
Name:LACKEY, SARAH (RN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:LACKEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3865 S MACKINAC TRL
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-9286
Mailing Address - Country:US
Mailing Address - Phone:906-635-3744
Mailing Address - Fax:
Practice Address - Street 1:3865 S MACKINAC TRL
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-9286
Practice Address - Country:US
Practice Address - Phone:906-635-3744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704307343163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health