Healthcare Provider Details

I. General information

NPI: 1699062042
Provider Name (Legal Business Name): SARA L ANDERSON NNP-BC, APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA L MELNICK APNP

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 S WEBSTER AVE
GREEN BAY WI
54301-3581
US

IV. Provider business mailing address

PO BOX 22487
GREEN BAY WI
54305-2487
US

V. Phone/Fax

Practice location:
  • Phone: 920-433-3500
  • Fax: 920-445-7301
Mailing address:
  • Phone: 920-445-7210
  • Fax: 920-445-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number8947-33
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number8947-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: