Provider Demographics
NPI:1952945172
Name:WILSON, SARAH L (CPM, LM)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:L
Last Name:WILSON
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5665 S GRANT RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-8143
Mailing Address - Country:US
Mailing Address - Phone:989-944-1758
Mailing Address - Fax:
Practice Address - Street 1:5665 S GRANT RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-8143
Practice Address - Country:US
Practice Address - Phone:989-944-1758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI19214080842176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife