Healthcare Provider Details

I. General information

NPI: 1174430045
Provider Name (Legal Business Name): SARA RAE NOESKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 N OAK CREST DR
WALES WI
53183-9711
US

IV. Provider business mailing address

563 A J ALLEN CIR
WALES WI
53183-9649
US

V. Phone/Fax

Practice location:
  • Phone: 262-968-6200
  • Fax: 262-965-6506
Mailing address:
  • Phone: 262-968-6200
  • Fax: 262-965-6506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number146389
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: