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NPI 1144317736

NPI 1144317736 : SARAH N STACHON PAC : KENOSHA, WI

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General NPI Number Information
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    NPI Number           |    1144317736
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    Entity Type          |    Individual 
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    Provider Name        |    SARAH N STACHON PAC
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    10/06/2006
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    Last Update Date     |    11/24/2021
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Provider Practice Location Address
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    Address Line         |    10400 75TH ST 
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    City                 |    KENOSHA
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    State                |    WI
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    Zip                  |    53142-7884
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    Country              |    US
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    Telephone            |    414-333-6169
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    Fax                  |    262-948-7329
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Provider Business Mailing Address
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    Address Line         |    10400 75TH ST ANESTHESIA
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    City                 |    KENOSHA
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    State                |    WI
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    Zip                  |    53142
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    Country              |    US
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    Telephone            |    262-948-6768
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    Fax                  |    262-948-7329
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    363A00000X
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    Taxonomy Name        |    Physician Assistant
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    License Number       |    1969023
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    License Number State |    WI
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