Provider Demographics
NPI:1093386245
Name:MOOTZ, SYDNEY ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:ELIZABETH
Last Name:MOOTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200B CHAMPAGNE ST
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-2973
Mailing Address - Country:US
Mailing Address - Phone:715-218-4024
Mailing Address - Fax:
Practice Address - Street 1:2400 PINE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-7803
Practice Address - Country:US
Practice Address - Phone:715-847-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant