Provider Demographics
NPI:1699062042
Name:ANDERSON, SARA L (NNP-BC, APNP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NNP-BC, APNP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:L
Other - Last Name:MELNICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:744 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3581
Practice Address - Country:US
Practice Address - Phone:920-433-3500
Practice Address - Fax:920-445-7301
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8947-33363LN0005X, 363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1699062042Medicaid
104423020OtherNATIONAL CERTIFICATION CORPORATION