Healthcare Provider Details

I. General information

NPI: 1801781588
Provider Name (Legal Business Name): SABRINA MARIE MORTENSEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 DIVISION ST
MAUSTON WI
53948-1931
US

IV. Provider business mailing address

1050 DIVISION ST
MAUSTON WI
53948-1931
US

V. Phone/Fax

Practice location:
  • Phone: 608-847-6161
  • Fax:
Mailing address:
  • Phone: 608-847-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number17077-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: