Provider Demographics
NPI:1053938324
Name:SAYLOR, SARA ROSEMARIE
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:ROSEMARIE
Last Name:SAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60920 40TH ST
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-9753
Mailing Address - Country:US
Mailing Address - Phone:269-491-2633
Mailing Address - Fax:
Practice Address - Street 1:4455 EDISON LAKES PKWY # 100
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1414
Practice Address - Country:US
Practice Address - Phone:574-231-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28240384A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28240384AOtherINDIANA STATE BOARD OF NURSING
MI4704278160OtherMICHIGAN STATE BOARD OF NURSING