Provider Demographics
NPI:1013243328
Name:SARAH'S LAB
Entity Type:Organization
Organization Name:SARAH'S LAB
Other - Org Name:DR. SARAH'S LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-215-2008
Mailing Address - Street 1:213 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-3862
Mailing Address - Country:US
Mailing Address - Phone:920-215-2008
Mailing Address - Fax:920-206-1666
Practice Address - Street 1:213 N. 4TH ST.
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-3806
Practice Address - Country:US
Practice Address - Phone:920-215-2008
Practice Address - Fax:920-206-1666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32001071959291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1013243328OtherCLINICAL MEDICAL LABORATORY