Provider Demographics
NPI:1023429586
Name:OTTEN, SARAH LYNN (NP-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNN
Last Name:OTTEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:LYNN
Other - Last Name:POPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39350 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-9164
Mailing Address - Country:US
Mailing Address - Phone:248-735-6081
Mailing Address - Fax:
Practice Address - Street 1:39350 9 MILE RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-9164
Practice Address - Country:US
Practice Address - Phone:248-735-6081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-17
Last Update Date:2014-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704272412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily