Healthcare Provider Details

I. General information

NPI: 1356204572
Provider Name (Legal Business Name): DR. SARAH MARIE MAGNUSSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 JUDY LN
MADISON WI
53704-1723
US

IV. Provider business mailing address

4705 JUDY LN
MADISON WI
53704-1723
US

V. Phone/Fax

Practice location:
  • Phone: 715-581-7678
  • Fax:
Mailing address:
  • Phone: 715-581-7678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number17532
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: