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General NPI Number Information
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NPI Number | 1700110947
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Entity Type | Individual
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Provider Name | SALLY J VAHOVICK PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/21/2009
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 2970 S CHASE AVE
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City | MILWAUKEE
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State | WI
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Zip | 53207-6407
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Country | US
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Telephone | 414-934-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 8444 N 90TH ST STE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4437
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Country | US
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Telephone | 602-248-8886
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2508-23
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License Number State | WI
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