Provider Demographics
NPI:1063694537
Name:KOLELL, SARA (APNP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:KOLELL
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 S KOELLER ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-6214
Mailing Address - Country:US
Mailing Address - Phone:920-223-7100
Mailing Address - Fax:920-223-7462
Practice Address - Street 1:1855 S KOELLER ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-6214
Practice Address - Country:US
Practice Address - Phone:920-223-7100
Practice Address - Fax:920-223-7462
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3296363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36054300Medicaid
WI710180706Medicare PIN