Provider Demographics
NPI:1578664199
Name:SONTAG, PATRICIA T (NP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:T
Last Name:SONTAG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3213 STEIN BLVD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6946
Mailing Address - Country:US
Mailing Address - Phone:715-552-9784
Mailing Address - Fax:715-835-6370
Practice Address - Street 1:714 W HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6937
Practice Address - Country:US
Practice Address - Phone:715-830-9990
Practice Address - Fax:715-830-9995
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100819363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43817000Medicaid
S79287Medicare UPIN
WI000320175Medicare PIN
WIWI2315006Medicare PIN