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General NPI Number Information
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NPI Number | 1619490786
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Entity Type | Individual
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Provider Name | HOLLY DORN SAPA
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Gender | Female
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Dates
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Enumeration Date | 07/20/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1125 WITTMANN DR
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City | MENASHA
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State | WI
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Zip | 54952-3607
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Country | US
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Telephone | 920-558-3600
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Fax | 920-997-8170
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Provider Business Mailing Address
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Address Line | 1125 WITTMANN DR
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City | MENASHA
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State | WI
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Zip | 54952-3607
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Country | US
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Telephone | 920-558-3600
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Fax | 920-997-8170
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | WI
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