Provider Demographics
NPI:1417072497
Name:COUILLARD, SARAH R R (LPN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:R R
Last Name:COUILLARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:R R
Other - Last Name:HEINRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 WEST SHORE DR
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018
Mailing Address - Country:US
Mailing Address - Phone:414-588-0393
Mailing Address - Fax:
Practice Address - Street 1:901 WEST SHORE DR
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018
Practice Address - Country:US
Practice Address - Phone:414-588-0393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse