Provider Demographics
NPI:1366877839
Name:WARREN, SARAH RAE (PA-C)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:RAE
Last Name:WARREN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 PAWNEE TRL
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2121
Mailing Address - Country:US
Mailing Address - Phone:517-896-3218
Mailing Address - Fax:
Practice Address - Street 1:5604 STAR FLOWER DR
Practice Address - Street 2:
Practice Address - City:HASLETT
Practice Address - State:MI
Practice Address - Zip Code:48840-8693
Practice Address - Country:US
Practice Address - Phone:517-896-3218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2018-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006729363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant