Provider Demographics
NPI:1013313675
Name:WUTZKE, SARA R (RN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:R
Last Name:WUTZKE
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 1:2430 ALLINGTON
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079-3602
Mailing Address - Country:US
Mailing Address - Phone:586-219-2654
Mailing Address - Fax:
Practice Address - Street 1:2430 ALLINGTON
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079-3602
Practice Address - Country:US
Practice Address - Phone:586-219-2654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704214709163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health