Healthcare Provider Details

I. General information

NPI: 1194913913
Provider Name (Legal Business Name): KAREN KAY DENTICE SAGER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 30TH AVE W
ALEXANDRIA MN
56308-3426
US

IV. Provider business mailing address

600 HIGHLAND AVE
MADISON WI
53792-0001
US

V. Phone/Fax

Practice location:
  • Phone: 320-763-5123
  • Fax:
Mailing address:
  • Phone: 608-263-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2140-23
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number2140-023
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: