Individual
SARA O'DONNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1604 SANBORN ST, PORT HURON, MI 48060-1908
(810) 434-3957
Mailing address
1604 SANBORN ST, PORT HURON, MI 48060-1908
(810) 434-3957
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125347
NATIONAL BOARD OF SURGICAL TECHNOLOGY AND SURGICAL ASSISTING
MI
Enumeration date
09/27/2016
Last updated
09/27/2016
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