Provider Demographics
NPI:1063420446
Name:SIEDENBURG, SARA J (CPNP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:J
Last Name:SIEDENBURG
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:J
Other - Last Name:FREYMILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:3239 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53206-3251
Mailing Address - Country:US
Mailing Address - Phone:414-264-0465
Mailing Address - Fax:414-264-2629
Practice Address - Street 1:3239 N 9TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53206-3251
Practice Address - Country:US
Practice Address - Phone:414-264-0465
Practice Address - Fax:414-264-2629
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI886-033363LP0200X
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI01750Medicare ID - Type Unspecified