Healthcare Provider Details

I. General information

NPI: 1447653993
Provider Name (Legal Business Name): MEGAN KAYE O'BRION SARDER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN KAYE O'BRION

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 S WEBSTER AVE
GREEN BAY WI
54301-3505
US

IV. Provider business mailing address

744 S WEBSTER AVE
GREEN BAY WI
54301-3581
US

V. Phone/Fax

Practice location:
  • Phone: 920-433-3640
  • Fax: 920-433-3716
Mailing address:
  • Phone: 920-433-3640
  • Fax: 920-433-3716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6093-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6093-022
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: