Provider Demographics
NPI:1326671033
Name:RUNDHAUG, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:RUNDHAUG
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 1:114 BUECHNER CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-3300
Mailing Address - Country:US
Mailing Address - Phone:920-917-9148
Mailing Address - Fax:
Practice Address - Street 1:4815 BAUTISTA DR
Practice Address - Street 2:
Practice Address - City:MC FARLAND
Practice Address - State:WI
Practice Address - Zip Code:53558-8737
Practice Address - Country:US
Practice Address - Phone:920-917-9148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI201444-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health