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General NPI Number Information
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NPI Number | 1417527862
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Entity Type | Individual
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Provider Name | SARA JAMAL FAIRAQ APNP
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Gender | Female
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Dates
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Enumeration Date | 06/28/2021
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Last Update Date | 07/08/2021
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Provider Practice Location Address
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Address Line | 9200 W WISCONSIN AVE
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City | MILWAUKEE
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State | WI
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Zip | 53226-3522
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Country | US
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Telephone | 414-955-0506
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Fax | 414-955-6211
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Provider Business Mailing Address
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Address Line | 11011 W NORTH AVE APT 446
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City | WAUWATOSA
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State | WI
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Zip | 53226-2274
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Country | US
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Telephone | 414-949-0082
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Fax |
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 1060033
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License Number State | WI
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