Provider Demographics
NPI:1972041846
Name:SAULSBERRY, PHEREN
Entity type:Individual
Prefix:
First Name:PHEREN
Middle Name:
Last Name:SAULSBERRY
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:PO BOX 44365
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-7365
Mailing Address - Country:US
Mailing Address - Phone:414-628-8794
Mailing Address - Fax:
Practice Address - Street 1:7873 W PALMETTO AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-3751
Practice Address - Country:US
Practice Address - Phone:414-628-8794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator