Healthcare Provider Details

I. General information

NPI: 1477225167
Provider Name (Legal Business Name): SARA J STEIN APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N20W22961 WATERTOWN RD
WAUKESHA WI
53186-1306
US

IV. Provider business mailing address

2428 N GRANDVIEW BLVD STE 102
WAUKESHA WI
53188-6906
US

V. Phone/Fax

Practice location:
  • Phone: 262-875-5070
  • Fax:
Mailing address:
  • Phone: 262-875-5070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number111272-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: