Healthcare Provider Details

I. General information

NPI: 1306468426
Provider Name (Legal Business Name): SARAH A MILLER APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH A JANKE APNP

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1976 LIME KILN RD
GREEN BAY WI
54311-4417
US

IV. Provider business mailing address

PO BOX 22487
GREEN BAY WI
54305-2487
US

V. Phone/Fax

Practice location:
  • Phone: 920-406-9865
  • Fax: 920-406-9867
Mailing address:
  • Phone: 920-445-7226
  • Fax: 920-445-7238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10174-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number177562-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: