Provider Demographics
NPI:1154057560
Name:EVERT, SARA L (RN)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:L
Last Name:EVERT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:798 ELLEN LN
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-6215
Mailing Address - Country:US
Mailing Address - Phone:920-251-7138
Mailing Address - Fax:
Practice Address - Street 1:798 ELLEN LN
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-6215
Practice Address - Country:US
Practice Address - Phone:920-251-7138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI226023163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice