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General NPI Number Information
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NPI Number | 1013243328
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Entity Type | Organization
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Legal Business Name | SARAH'S LAB
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Dates
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Enumeration Date | 10/20/2009
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Last Update Date | 02/16/2017
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Provider Practice Location Address
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Address Line | 213 N. 4TH ST.
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City | WATERTOWN
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State | WI
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Zip | 53094-3806
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Country | US
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Telephone | 920-215-2008
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Fax | 920-206-1666
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Provider Business Mailing Address
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Address Line | 213 N 4TH ST
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City | WATERTOWN
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State | WI
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Zip | 53094-3862
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Country | US
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Telephone | 920-215-2008
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Fax | 920-206-1666
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Authorized Official
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Title or Position | OWNER
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Name | SARAH KISER
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Credential |
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Telephone | 920-215-2008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 32001071959
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License Number State | FL
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