MEDICARE: MS. SARAH PACKMAN APNP

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	363LA2200X	Adult Health Nurse Practitioner	766-033	WI

General Provider Information

NPI Number	:	1942296215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARAH PACKMAN APNP

Provider Business Mailing Address
First Line	:	424 W RAVINE BAYE RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53217-1337
Country	:	US
Telephone Number	:	414-247-2019
Fax Number	:

Provider Business Practice Location Address
First Line	:	1702 W WALNUT ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1616
Country	:	US
Telephone Number	:	414-933-1300
Fax Number	:

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

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	07/09/2007

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