Individual
SARAH BOOMSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
(616) 391-6243
Mailing address
100 MICHIGAN ST NE, MC 109 ATTN JULIE L, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704218762
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1558407189
GROUP NPI
MI
05
—
4696370
—
MI
01
—
5008704590
BCBS INDIVIDUAL PIN
MI
Enumeration date
06/07/2006
Last updated
07/09/2007
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