Healthcare Provider Details

I. General information

NPI: 1538631940
Provider Name (Legal Business Name): SARA MARSHALL APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA LOUGHRIN

II. Dates (important events)

Enumeration Date: 12/24/2018
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6408 COPPS AVE
MONONA WI
53716-3702
US

IV. Provider business mailing address

202 S PARK ST
MADISON WI
53715-1507
US

V. Phone/Fax

Practice location:
  • Phone: 608-417-3000
  • Fax: 608-417-3100
Mailing address:
  • Phone: 608-417-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number157426
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9017-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: