Provider Demographics
NPI:1811207012
Name:ENDICOTT, SARAH ELISA (MSN, GNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELISA
Last Name:ENDICOTT
Suffix:
Gender:F
Credentials:MSN, GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 1ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW GLARUS
Mailing Address - State:WI
Mailing Address - Zip Code:53574-8876
Mailing Address - Country:US
Mailing Address - Phone:608-214-8006
Mailing Address - Fax:
Practice Address - Street 1:918 1ST ST
Practice Address - Street 2:
Practice Address - City:NEW GLARUS
Practice Address - State:WI
Practice Address - Zip Code:53574-8876
Practice Address - Country:US
Practice Address - Phone:608-214-8006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4224-33363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology