Provider Demographics
NPI:1962774992
Name:VICARI, SARAH HELEN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:HELEN
Last Name:VICARI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:H
Other - Last Name:PEERENBOOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9146
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:10500 W LOOMIS RD
Practice Address - Street 2:SUITE 110
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8030
Practice Address - Country:US
Practice Address - Phone:262-898-4400
Practice Address - Fax:414-858-9104
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003140363A00000X
WI3663-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant