Healthcare Provider Details

I. General information

NPI: 1023783362
Provider Name (Legal Business Name): SARAH K WYCHECK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5708 PECAN BROOK DR
AUSTIN TX
78724-3345
US

IV. Provider business mailing address

5708 PECAN BROOK DR
AUSTIN TX
78724-3345
US

V. Phone/Fax

Practice location:
  • Phone: 717-712-9131
  • Fax:
Mailing address:
  • Phone: 717-712-9131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1049328
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: