Provider Demographics
NPI:1821556317
Name:GRETENHART, SARA (APNP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:GRETENHART
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:BARTOSHEVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3108 E HAMMOND AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-1811
Mailing Address - Country:US
Mailing Address - Phone:414-722-2947
Mailing Address - Fax:
Practice Address - Street 1:3108 E HAMMOND AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-1811
Practice Address - Country:US
Practice Address - Phone:414-722-2947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8850-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily