Healthcare Provider Details

I. General information

NPI: 1295764736
Provider Name (Legal Business Name): SARAH A VAN SAUN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH A RICHARD PA

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21700 INTERTECH DR
BROOKFIELD WI
53045-5197
US

IV. Provider business mailing address

21700 INTERTECH DR
BROOKFIELD WI
53045-5197
US

V. Phone/Fax

Practice location:
  • Phone: 262-532-8300
  • Fax:
Mailing address:
  • Phone: 262-532-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1798
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number1798
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: