Provider Demographics
NPI:1932158029
Name:WILLEY, SARAH J (ANP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:J
Last Name:WILLEY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 M 119 STE C
Mailing Address - Street 2:
Mailing Address - City:HARBOR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49740-9373
Mailing Address - Country:US
Mailing Address - Phone:231-348-9900
Mailing Address - Fax:
Practice Address - Street 1:3434 M 119 STE C
Practice Address - Street 2:
Practice Address - City:HARBOR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49740-9373
Practice Address - Country:US
Practice Address - Phone:231-348-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704101925363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN21790022Medicare PIN
P31210Medicare UPIN
ON23850005Medicare ID - Type Unspecified
MI500A710160OtherBCBS