1104157098 NPI number — SARAH MARIE PENZEL NP

Table of content: SARAH MARIE PENZEL NP (NPI 1104157098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104157098 NPI number — SARAH MARIE PENZEL NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENZEL
Provider First Name:
SARAH
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LYNCH
Provider Other First Name:
SARAH
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104157098
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2313 E HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND BLANC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48439-5059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-953-6400
Provider Business Mailing Address Fax Number:
810-953-6477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 S BALLENGER HWY
Provider Second Line Business Practice Location Address:
PHYSICIAN BILLING
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48532-3638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-342-1000
Provider Business Practice Location Address Fax Number:
810-342-1590
Provider Enumeration Date:
01/18/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  4704270819 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)