Healthcare Provider Details

I. General information

NPI: 1740918754
Provider Name (Legal Business Name): SARA EBSEN AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA GLOMSKI

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36500 AURORA DR
SUMMIT WI
53066-4899
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-434-5000
  • Fax: 262-434-7950
Mailing address:
  • Phone: 800-326-2250
  • Fax: 414-805-6864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13424-033
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number232463
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: