Provider Demographics
NPI:1053995944
Name:KARL-LUSARDI, SARA (NP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:KARL-LUSARDI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 E BELTLINE AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-6045
Mailing Address - Country:US
Mailing Address - Phone:616-456-8553
Mailing Address - Fax:
Practice Address - Street 1:3210 EAGLE RUN DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7051
Practice Address - Country:US
Practice Address - Phone:616-456-9553
Practice Address - Fax:616-454-5371
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704306640363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner