Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 5482-33 | WI |
NPI | 1003242306 |
---|---|
Provider Name | Sarah Michelle Anderson |
First Address | Bloomington, MN 55425-4516 |
Second Address | New Richmond, WI 54017-1449 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2013 |
Last Update Date | 30/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5482-33 | STATE LICENSE (01) | WI |