Provider Demographics
NPI:1508815820
Name:HERMSDORF, SARAH T (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:T
Last Name:HERMSDORF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:T
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:700 S PARK ST
Mailing Address - Street 2:DEAN & ST. MARY'S OUTPATIENT CENTER
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1830
Mailing Address - Country:US
Mailing Address - Phone:608-260-2900
Mailing Address - Fax:
Practice Address - Street 1:700 S PARK ST
Practice Address - Street 2:DEAN & ST. MARY'S OUTPATIENT CENTER
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1830
Practice Address - Country:US
Practice Address - Phone:608-260-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1733-023363AM0700X, 363AS0400X
WI1733363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1508815820Medicaid
WI60287OtherDEAN HEALTH INSURANCE
WI60287OtherDEAN HEALTH INSURANCE
WI41991900Medicaid