Provider Demographics
NPI:1295720092
Name:VANDEVEN, SARAH KOOP (MSN, CRNP)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:KOOP
Last Name:VANDEVEN
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 PARCHMENT DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3662
Mailing Address - Country:US
Mailing Address - Phone:616-949-4840
Mailing Address - Fax:616-949-3531
Practice Address - Street 1:970 PARCHMENT DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3662
Practice Address - Country:US
Practice Address - Phone:717-843-6663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR160912363LF0000X
PASP008691363LF0000X
MI4704255877363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q39831Medicare UPIN