Provider Demographics
NPI:1164999678
Name:MAND, SARA L (RN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:L
Last Name:MAND
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 1:14798 BEAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SOLDIERS GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:54655-6524
Mailing Address - Country:US
Mailing Address - Phone:608-669-1672
Mailing Address - Fax:
Practice Address - Street 1:14798 BEAR CREEK DR
Practice Address - Street 2:
Practice Address - City:SOLDIERS GROVE
Practice Address - State:WI
Practice Address - Zip Code:54655-6524
Practice Address - Country:US
Practice Address - Phone:608-669-1672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163396163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health