Provider Demographics
NPI:1225737315
Name:ALTSTAETTER, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:ALTSTAETTER
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 1:1538 ARIZONA PASS
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-1804
Mailing Address - Country:US
Mailing Address - Phone:608-886-7394
Mailing Address - Fax:
Practice Address - Street 1:1538 ARIZONA PASS
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-1804
Practice Address - Country:US
Practice Address - Phone:608-886-7394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1102265163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1102265Medicaid