Basic Information
| Provider Information | |||||||||
| NPI: | 1538631940 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARSHALL | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | |||||||||
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| Credential: | APNP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | LOUGHRIN | ||||||||
| OtherFirstName: | SARA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 202 S PARK ST | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537151507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6084176000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6408 COPPS AVE | ||||||||
| Address2: | |||||||||
| City: | MONONA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537163702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6084173000 | ||||||||
| FaxNumber: | 6084173100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/24/2018 | ||||||||
| LastUpdateDate: | 01/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 157426 | WI | N | Nursing Service Providers | Registered Nurse | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 363L00000X | 9017-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.