Provider Demographics
NPI:1912034877
Name:SATA, MIRIAM CHRISTINE (MSN RN AGNP-C)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:CHRISTINE
Last Name:SATA
Suffix:
Gender:F
Credentials:MSN RN AGNP-C
Other - Prefix:MS
Other - First Name:MIRIAM
Other - Middle Name:CHRISTINE
Other - Last Name:SATA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:2060 BARBERRY DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-1179
Mailing Address - Country:US
Mailing Address - Phone:248-318-1175
Mailing Address - Fax:
Practice Address - Street 1:35 W HURON ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2120
Practice Address - Country:US
Practice Address - Phone:248-335-0632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704127925363LA2200X, 363LG0600X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult