Healthcare Provider Details

I. General information

NPI: 1114432259
Provider Name (Legal Business Name): SARAH A TRUESDALE APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH A BERGMAN

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S HERITAGE WOODS DR
APPLETON WI
54915-1408
US

IV. Provider business mailing address

122 E COLLEGE AVE
APPLETON WI
54911-5794
US

V. Phone/Fax

Practice location:
  • Phone: 920-225-7875
  • Fax: 920-993-5003
Mailing address:
  • Phone: 920-996-3264
  • Fax: 920-830-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number190356
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8272
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: