Healthcare Provider Details

I. General information

NPI: 1679947006
Provider Name (Legal Business Name): SARAH L ELLIOT MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W SUMMIT AVE STE 290
WALES WI
53183-9427
US

IV. Provider business mailing address

150 S HUNTINGTON AVE VA BOSTON HEALTHCARE SYSTEM (C&P/11)
BOSTON MA
02130-4817
US

V. Phone/Fax

Practice location:
  • Phone: 844-726-3926
  • Fax: 844-726-3926
Mailing address:
  • Phone: 857-364-5569
  • Fax: 857-364-6016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number135512-30
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP151175
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7556-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: