Provider Demographics
NPI:1639764970
Name:SYNDERGAARD, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SYNDERGAARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2000 E MILESTONE DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-6701
Mailing Address - Country:US
Mailing Address - Phone:920-731-8131
Mailing Address - Fax:920-832-0444
Practice Address - Street 1:2000 E MILESTONE DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-6701
Practice Address - Country:US
Practice Address - Phone:920-731-8131
Practice Address - Fax:920-832-0444
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5547-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant