Provider Demographics
NPI:1629465562
Name:PURZNER-WELSH, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:PURZNER-WELSH
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 1:23963 FLINT AVE
Mailing Address - Street 2:
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-4206
Mailing Address - Country:US
Mailing Address - Phone:608-343-2421
Mailing Address - Fax:
Practice Address - Street 1:23963 FLINT AVE
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-4206
Practice Address - Country:US
Practice Address - Phone:608-343-2421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-17
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI314458-31164W00000X
WI263573-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse