Provider Demographics
NPI:1427744465
Name:STEVENSON, SARA KATHLEEN (FNP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:KATHLEEN
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 E REDDING CIR
Mailing Address - Street 2:
Mailing Address - City:BELGIUM
Mailing Address - State:WI
Mailing Address - Zip Code:53004-9424
Mailing Address - Country:US
Mailing Address - Phone:262-617-8468
Mailing Address - Fax:
Practice Address - Street 1:12831 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-2400
Practice Address - Country:US
Practice Address - Phone:262-243-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13801363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily