MEDICARE: SANDRA DUERST RN

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	163W00000X	Registered Nurse	173273-30	WI

General Provider Information

NPI Number	:	1952677106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA DUERST RN

Provider Business Mailing Address
First Line	:	S10303A SKUNK VALLEY RD
Second Line	:
City	:	SAUK CITY
State	:	WI
Zip	:	53583-9661
Country	:	US
Telephone Number	:	608-225-9475
Fax Number	:

Provider Business Practice Location Address
First Line	:	S10303A SKUNK VALLEY RD
Second Line	:
City	:	SAUK CITY
State	:	WI
Zip	:	53583-9661
Country	:	US
Telephone Number	:	608-225-9475
Fax Number	:

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

Provider Enumeration Date	:	03/31/2012
Last Update Date	:	03/31/2012

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