Provider Demographics
NPI:1700371325
Name:BRUBAKER, SARA MICHELLE (CHW, LPN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MICHELLE
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:CHW, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 SE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-2778
Mailing Address - Country:US
Mailing Address - Phone:218-326-5114
Mailing Address - Fax:218-999-4041
Practice Address - Street 1:3130 SE 2ND AVE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2778
Practice Address - Country:US
Practice Address - Phone:218-326-5114
Practice Address - Fax:218-999-4041
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker