Provider Demographics
NPI:1528697638
Name:STITES, SARA A (CPM, LM)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:A
Last Name:STITES
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 21 3/4 ST
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:WI
Mailing Address - Zip Code:54822-9714
Mailing Address - Country:US
Mailing Address - Phone:715-651-3857
Mailing Address - Fax:
Practice Address - Street 1:1285 21 3/4 ST
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:WI
Practice Address - Zip Code:54822-9714
Practice Address - Country:US
Practice Address - Phone:715-651-3857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI242-49176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife