MEDICARE: SARA J SIEDENBURG CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	886-033	WI
2	163W00000X	Registered Nurse		WI

General Provider Information

NPI Number	:	1063420446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA J SIEDENBURG CPNP

Provider Business Mailing Address
First Line	:	3239 N 9TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53206-3251
Country	:	US
Telephone Number	:	414-264-0465
Fax Number	:	414-264-2629

Provider Business Practice Location Address
First Line	:	3239 N 9TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53206-3251
Country	:	US
Telephone Number	:	414-264-0465
Fax Number	:	414-264-2629

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	09/11/2025

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