Provider Demographics
NPI:1235514407
Name:WISSEMEIER, SARAH (CNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:WISSEMEIER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5712 NW LADY MARNA AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-2000
Mailing Address - Country:US
Mailing Address - Phone:513-509-3617
Mailing Address - Fax:
Practice Address - Street 1:3428 NW CACHE RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-3846
Practice Address - Country:US
Practice Address - Phone:580-595-7207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK116875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily