Provider Demographics
NPI:1790235653
Name:SARBACKER, KATIE LOUISE (RN)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LOUISE
Last Name:SARBACKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LOUISE
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:725 CANOPY DR APT 305
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-5823
Mailing Address - Country:US
Mailing Address - Phone:608-417-9017
Mailing Address - Fax:
Practice Address - Street 1:725 CANOPY DR APT 305
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-5823
Practice Address - Country:US
Practice Address - Phone:608-417-9017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI229940163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse