Provider Demographics
NPI:1659579514
Name:LOWE, SARA A (NP)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:A
Last Name:LOWE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:A
Other - Last Name:PUESTOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC ALLERGY AND IMMUNOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-6840
Mailing Address - Fax:414-266-6437
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC ALLERGY AND IMMUNOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-6840
Practice Address - Fax:414-266-6437
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI147735363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1659579514Medicaid
WI1659579514Medicaid