Provider Demographics
NPI:1942225339
Name:JAEGER, SARAH E (PA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:JAEGER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403
Mailing Address - Country:US
Mailing Address - Phone:715-848-4884
Mailing Address - Fax:718-845-5385
Practice Address - Street 1:1810 N 2ND ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401
Practice Address - Country:US
Practice Address - Phone:715-848-4884
Practice Address - Fax:715-845-5385
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1806363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41997200Medicaid
Q30863Medicare UPIN
WI41997200Medicaid