Provider Demographics
NPI:1558448845
Name:LAROSA, SALLY (NP)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:LAROSA
Suffix:
Gender:F
Credentials:NP
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6801 N YATES RD
Mailing Address - Street 2:CARDINAL STRITCH STUDENT HEALTH CENTER
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3945
Mailing Address - Country:US
Mailing Address - Phone:414-410-4854
Mailing Address - Fax:414-410-4094
Practice Address - Street 1:6801 N YATES RD
Practice Address - Street 2:CARDINAL STRITCH STUDENT HEALTH CENTER
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-3945
Practice Address - Country:US
Practice Address - Phone:414-410-4854
Practice Address - Fax:414-410-4094
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2014-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI927363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39875900Medicaid
WI39875900Medicaid