Healthcare Provider Details

I. General information

NPI: 1053055814
Provider Name (Legal Business Name): SARA ELIZABETH SCHLESNER VAUGHN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 CROOKED TREE DR
DEFOREST WI
53532-9113
US

IV. Provider business mailing address

119 CROOKED TREE DR
DEFOREST WI
53532-9113
US

V. Phone/Fax

Practice location:
  • Phone: 262-853-7007
  • Fax:
Mailing address:
  • Phone: 262-853-7007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13031
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number224996
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: