Healthcare Provider Details

I. General information

NPI: 1518513639
Provider Name (Legal Business Name): SARAH LYNNE GERARD CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH LYNNE WIEDERHOFT

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WEST AVE S
LA CROSSE WI
54601-8806
US

IV. Provider business mailing address

PO BOX 860912
MINNEAPOLIS MN
55486-0912
US

V. Phone/Fax

Practice location:
  • Phone: 608-785-0940
  • Fax:
Mailing address:
  • Phone: 608-785-0940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6796
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number6796
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9584
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: