Provider Demographics
NPI:1568954337
Name:SLIVON, SARAH M (APNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:SLIVON
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5031
Mailing Address - Country:US
Mailing Address - Phone:262-656-5330
Mailing Address - Fax:262-653-5346
Practice Address - Street 1:6308 8TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-5031
Practice Address - Country:US
Practice Address - Phone:262-653-5330
Practice Address - Fax:262-653-5346
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI190388-30364S00000X
WI8473-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI190388-30OtherRN LICENSE
WI1568954337Medicaid
WI8473-33OtherAPNP LICENSE