Provider Demographics
NPI:1962141952
Name:GREGORICH, SARA L
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:L
Last Name:GREGORICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4152
Mailing Address - Country:US
Mailing Address - Phone:715-847-2558
Mailing Address - Fax:715-847-2752
Practice Address - Street 1:3225 BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54482-8837
Practice Address - Country:US
Practice Address - Phone:715-847-2558
Practice Address - Fax:715-261-6452
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11974-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily