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General NPI Number Information
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NPI Number | 1760994404
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Entity Type | Individual
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Provider Name | SARAH RAE WICKENHAUSER FNP-C, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 11/03/2017
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 5220 6TH STREET FRONTAGE RD E
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City | SPRINGFIELD
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State | IL
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Zip | 62703-5735
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Country | US
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Telephone | 217-993-0998
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Fax | 217-529-4228
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Provider Business Mailing Address
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Address Line | PO BOX 748465
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City | ATLANTA
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State | GA
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Zip | 30374-8465
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Country | US
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Telephone | 855-284-7483
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Fax | 617-807-0958
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209016863
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209016863
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License Number State | IL
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