Healthcare Provider Details

I. General information

NPI: 1134484611
Provider Name (Legal Business Name): SARAH J REZIN APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH J MALY RN

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E VETERANS ST
TOMAH WI
54660-3105
US

IV. Provider business mailing address

500 E VETERANS ST
TOMAH WI
54660-3105
US

V. Phone/Fax

Practice location:
  • Phone: 608-372-3971
  • Fax: 608-372-1240
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14958-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number162865-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: