Healthcare Provider Details

I. General information

NPI: 1497352728
Provider Name (Legal Business Name): SARAH EMMERICH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 W WISCONSIN AVE
MILWAUKEE WI
53208-3182
US

IV. Provider business mailing address

1127 WISTERIA LN
WAUKESHA WI
53189-7248
US

V. Phone/Fax

Practice location:
  • Phone: 414-291-2626
  • Fax:
Mailing address:
  • Phone: 920-321-4442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10126-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: